Orthopedic Surgical Claims Specialist - Onsite

The CORE Institute; Florida; On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Competitive health benefits

HSA with company contributions

401(k) plan with company match

Paid time off

Job summary

Center for Bone & Joint Surgery is seeking an experienced Insurance Follow-Up Representative-Coder Collections to join our Revenue Cycle team at our Royal Palm Beach, FL location. This on-site role focuses on complex surgical claims, denials, and appeals to maximize reimbursement for orthopedic services.

The ideal candidate is CPC or CCS certified with orthopedic billing experience, proficient in ICD-10/CPT coding, and able to work collaboratively with providers, payers, and staff to resolve

Qualifications

• Certified professional coder (CPC) or CCS certification required.
• Orthopedic billing experience preferred.
• Minimum 2 years of experience in medical billing, collections, insurance follow-up, or revenue cycle management.

Responsibilities

• Review and resolve complex surgical claim denials, underpayments, and rejections by identifying root causes and executing effective appeal strategies.
• Analyze denied and unpaid orthopedic surgical claims and submit well-supported appeals to maximize reimbursement.
• Verify patient demographic information, insurance eligibility, and COB; update records as needed to ensure accurate claim processing.
• Confirm claim receipt with insurance carriers and monitor claim status to facilitate timely payment.
• Research and obtain all required documentation to support claim adjudication and appeals.
• Interpret and apply payer-specific reimbursement guidelines, medical necessity requirements, and billing policies.
• Review coding, modifiers, and claim edits to ensure CPT/ICD-10 compliance.
• Take ownership of assigned accounts receivable and work aging accounts to reduce balances.
• Communicate findings to leadership about denial trends and revenue cycle opportunities.

Skills

CPC certification

CCS certification

Orthopedic billing

Denial management

Athena EMR

Tools

Athena EMR

Job description

Center for Bone & Joint Surgery is seeking an experienced Insurance Follow-Up Representative-Coder Collections to join our Revenue Cycle team at our Royal Palm Beach, FL location. This on-site role focuses on complex surgical claims, denials, and appeals to maximize reimbursement for orthopedic services.

The ideal candidate is CPC or CCS certified with orthopedic billing experience, proficient in ICD-10/CPT coding, and able to work collaboratively with providers, payers, and staff to resolve