Billing Specialist

🕒 April 15

🌵 Arizona – Remote

🌵 Arizona – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

📊 Billing Specialist

🚫👨‍🎓 No degree required

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Healthcare Outcomes Performance Co. (HOPCo)

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🤝 B2B

☁️ SaaS

💰 Private equity on 2019-02

B2B • SaaS

Healthcare Outcomes Performance Co. (HOPCo) is the largest orthopedic value-based care organization in the U. S. , specializing in comprehensive musculoskeletal (MSK) care delivery, management, and value creation. Led by orthopedic physicians and executives, HOPCo operates an accredited MSK clinically integrated network and offers practice partnership and health system solutions, payor-facing population health and value-based care programs, analytics and outcomes reporting, and digital patient engagement tools to align stakeholders, improve outcomes, and lower total MSK costs.

📋 Description

• Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers. • Review and prepare claims for manual and/or electronic billing submission. • Reviews insurance rejections to determine the next appropriate action steps and obtain the necessary information to resolve any outstanding rejections. • Correct and identify billing errors and resubmit claims to insurance carriers. • Update CAS segments on secondary electronic claims as needed. • Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans. • Verifies receipt of claim with insurance plans, determining the next appropriate action step. • Researches all information needed to complete the billing process including obtaining information from providers, ancillary services staff, and patients. • Obtains and attaches referrals to appointments/charges. • Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals. • Identifies and communicates trends and/or potential issues to the management team. • Follows and maintains all HOPCo policies and procedures.

🎯 Requirements

• High school diploma/GED or equivalent working knowledge preferred. • Minimum of two to three years of experience in medical billing. • Prior experience working on claim errors in a claims management system preferred. • Strong knowledge of resolution to payor edit reports, and reconciliation of clearinghouse and payor acceptance reports. • Candidates with knowledge of ANSI formatting preferred. • Knowledge of ICD-9, ICD-10, HCPS, and CPT coding, medical terminology, Medicare reimbursement guidelines, billing practices. • Knowledge of government regulatory requirements and commercial contracts. • Advanced computer knowledge, including Window based programs.

🏖️ Benefits

• Equal Opportunity Employer