Orthopedic Claims & Operations Manager (EPIC)

Genesis-Orthopedics-; Aurora (IL); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Genesis Orthopedics & Sports Medicine in Aurora, IL, is seeking a Front Office Manager to lead the administrative operations of six outpatient physical therapy clinics with a hybrid work arrangement. You will supervise claims, denials, and AR processes, ensure HIPAA compliance, and coordinate with billing, coding, and management to optimize performance and patient service.

Ideal candidates have 3–5 years of medical claims management, hands-on EPIC experience, and strong Excel skills; excellent

Qualifications

• 3–5 years of experience in medical claims management or billing, with a strong focus on orthopedic claims.
• Proven experience leading a claims or AR team in a healthcare setting.
• Hands-on experience with EPIC system is required.
• Excellent understanding of CPT/HCPCS codes, modifiers, EOBs, ERAs, CARC/RARC codes, and payer-specific denial handling.
• Advanced Excel skills (pivot tables, lookups, trend tracking).

Responsibilities

• Daily Oversight of administrative operations of 6 outpatient physical therapy clinics.
• Review and validate all contractual adjustments and ensure accuracy in claim posting and payer compliance.
• Download and allocate new accounts to analysts from multiple EPIC workqueues based on payer, aging, and priority.
• Audit processed claims for accuracy, completeness, and timeliness before submission or follow-up.
• Perform quality checks and ensure analysts follow correct claim handling procedures.
• Conduct daily and weekly performance reviews, tracking productivity and accuracy metrics.
• Oversee denial trending and root cause analysis for all orthopedic-related claims.
• Identify and escalation systemic issues such as incorrect coding, missing documentation, or payer configuration errors.
• Work closely with billing, coding, and authorization teams to resolve high-value or high-impact claims.
• Ensure claims are submitted, followed up, and appealed in accordance with payer guidelines and timely filing limits.
• Prepare and distribute daily, weekly, and monthly reports on claim status, denial trends, and AR performance.
• Monitor KPIs such as denial rate, claim turnaround time, and first-pass resolution rate.
• Track performance metrics for the entire team and provide data-driven recommendations for improvement.
• Ensure all claim activities comply with HIPAA, payer rules, and internal SOPs.
• Stay current with orthopedic coding changes, payer updates, and EPIC workflows.
• Recommend and implement process improvements to enhance claim accuracy and reduce rework.
• Participate in audits and provide supporting claim documentation when required.

Skills

Medical claims management

EPIC experience

CPT/HCPCS knowledge

Excel (advanced)

Tools

EPIC

Microsoft Excel

Job description

Genesis Orthopedics & Sports Medicine in Aurora, IL, is seeking a Front Office Manager to lead the administrative operations of six outpatient physical therapy clinics with a hybrid work arrangement. You will supervise claims, denials, and AR processes, ensure HIPAA compliance, and coordinate with billing, coding, and management to optimize performance and patient service.

Ideal candidates have 3–5 years of medical claims management, hands-on EPIC experience, and strong Excel skills; excellent