Claims Resolution Specialist

Job not on LinkedIn

🔥 21 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Orthopedic Care Partners

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

Orthopedic Care Partners (OCP) is a leading and expansive network of orthopedic care providers, offering a comprehensive growth platform for orthopedic practices across the United States. OCP is known for its superior clinical reputation, scaled infrastructure, and outstanding patient experience. Through strategic partnerships and affiliations, OCP has become one of the largest orthopedic platforms, supported by over 138 physician partners and 42 clinics. They focus on maintaining clinical autonomy for practices, while leveraging shared resources to optimize value-based care. OCP is actively involved in Medicare’s BPCI Program and commercial bundled contracts, capitalizing on data analytics to enhance patient outcomes and reduce costs. Their commitment is to superior clinical outcomes and a great patient experience, while providing a vertically integrated clinical offering and strong physician alignment. The company is well positioned to thrive within the healthcare industry's shifts towards value-based care models.

📋 Description

• Submit and track insurance and patient claims for government and commercial payers • Perform timely follow-up on unpaid or denied claims to ensure proper reimbursement • Conduct root cause analysis on recurring denials or payment issues and escalate trends to management • Research payer policies and claim-specific requirements • Process write-offs and adjustments according to established protocols and payer contracts • Maintain clear, accurate documentation of claim-related activities and communications • Collaborate with clinical, billing, and coding staff to resolve claim issues • Monitor aging reports and prioritize follow-up based on payer deadlines and financial impact • Prepare reports and summaries of problem accounts, denial patterns, and process inefficiencies • Assist in implementing process improvements to reduce denials and enhance revenue cycle performance • Ensure compliance with HIPAA, payer guidelines, and internal billing policies • Perform other duties as assigned

🎯 Requirements

• High school diploma or equivalent required; associate's or bachelor's degree in healthcare administration, business, or related field preferred • 2+ years of experience in medical billing, claims follow-up, or revenue cycle management required, preferably in Orthopedics • Working knowledge of government and commercial payer guidelines, medical terminology, CPT/ICD-10 coding, and insurance billing practices • Experience with Electronic Health Record (EHR) and Practice Management systems (e.g., ModMed, Epic, Athena, etc.) • Ability to work independently, meet deadlines, and adapt in a fast-paced environment • Experience communicating with patients regarding billing questions and payment options is a plus • Strong data entry and documentation skills • Proficiency with Microsoft Office Suite, particularly Excel and Outlook • Understanding of claim adjudication, payment posting, and denial management processes • Ability to fulfill office activities, including remaining seated for computer-based work, filing, and lifting/carrying office supplies • Occasionally lift and/or move up to 20–25 pounds • Travel may be required to existing or new OCP locations