Reimbursement Variance Analyst

Orthopedic ONE; Westerville (OH); On-site; USD 50,000 - 60,000; Full time

Job summary

Orthopedic One is seeking a Billing Specialist to maintain clinic professional charges, update procedure and diagnosis codes, and manage refunds in the practice management system.

You will analyze reimbursement data, perform variance analyses, ensure compliance with payer rules, and collaborate with patients, providers, and the finance team in a fast-paced orthopedic setting.

Qualifications

• High School Diploma or equivalent is required.
• Previous medical billing experience, preferably in an orthopedic surgery specialty, is required.
• Current Certified Professional Coder (CPC) certification is required.
• Proficiency with practice management software and Microsoft Excel is required.

Responsibilities

• Maintains fee schedules by updating payer allowed amounts annually and attaching new schedules to all providers.
• Performs payment variance analyses and corrects inaccurate allowed amounts in fee schedules; assists with appeals of underpayments.
• Validates and processes insurance overpayments and refunds; coordinates with finance and A/R teams.
• Communicates with patients, carriers, and staff to resolve billing issues and provide professional customer service.
• Works collaboratively to support department workflows and adheres to policies and procedures in the employee handbook.
• Complies with all policies and procedures and supports risk management programs.

Skills

Medical billing experience

Education

High School Diploma or equivalent

Certified Professional Coder

Tools

Practice management systems

Microsoft Excel

Job description

Position Summary

Responsible for maintenance of clinic professional charges including updating of procedure and diagnosis codes and associated fee schedule in the practice management system, analysis of reimbursement data to identify and resolve variances, and patient and insurance refunds.

Responsibilities and Accountabilities

• Fee Schedule Maintenance
  • Updates existing fee schedules with payer allowed amounts annually (or as necessary)
  • Attaches new schedules to all providers and expires old schedules
  • Monitors CMS and commercial payer websites and transmittals for regulatory changes in reimbursement policies
  • Revises standard fees to comply with federal and state billing regulations and guidelines
• Payment Variance Analysis
  • Runs carrier variance reports and researches payment inconsistencies identified
  • Corrects invalid allowed amounts in corresponding fee schedules
  • Appeals underpayment errors with carriers
  • Identifies and reports carrier trends to the director
• Insurance Overpayments and Refunds
  • Validates insurance overpayments in demand letters from carriers and refund requests from A/R reps, making appropriate account adjustments as needed
  • Runs monthly credit balance reports to identify patient overpayments, conveys funds when appropriate, and places account in refund status
  • Forwards refund requests to the finance department with supporting documentation
  • Processes patient and insurance refund checks for mailing with appropriate claim reconsideration forms or explanation letters, verifying payee name and address
  • Analyzes overpayment trends and recommends corrective procedures
• Customer Service and Communications
  • Communicates with patients, insurance carriers and other outside entities in a professional manner, identifying solutions and responding professionally to patient concerns
  • Diffuses negative situations with patients and maintains a pleasant and professional tone during stressful circumstances and high workload
  • Communicates with staff members in a professional, pleasant manner; shares relevant information, avoids gossip, accepts work without complaint and provides reasons when assignments are unmanageable, asking and answering questions that improve department performance
• Teamwork
  • Willingly provides coverage, volunteers assistance, and maintains workflows within the department without direct instruction or supervision
  • Works cooperatively and refrains from participating in negative conversations
  • Shares knowledge and insights with co‑workers in a constructive manner
  • Works to solve problems and address conflicts directly with the appropriate person before involving leadership or uninvolved peers
  • Considers others in the work environment with regard to taking breaks, meal periods, use of computer and phone, and noise level
• Policies and Procedures
  • Knows and complies with policies and procedures enumerated in the Orthopedic One Employee Handbook and related documents
  • Provides assistance and support to leadership in implementing policies and procedures as necessary
  • Actively participates in training and conducts day‑to‑day work activities in adherence to all policies and procedures enumerated in compliance and risk management programs

Qualifications

• High School Diploma or equivalent required
• Previous medical billing experience, preferably in an orthopedic surgery specialty, required
• Current certification as a Certified Professional Coder required
• Proficiency with software including practice management systems and Microsoft Excel

Location: Orthopedic One

Patient Accounts Schedule: Regular Full Time, Day Shift