Health Claims Collections Specialist II

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🤠 Texas – Remote

🤠 Texas – Remote

💵 $23 - $26 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📞 Collections

🚫👨‍🎓 No degree required

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Orthofix

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

🧬 Biotechnology

Healthcare Insurance • Medical Devices • Biotechnology

Orthofix is a global medical device company focused on developing innovative solutions for spinal and orthopedic conditions. The company offers a range of products and therapies, including biologics, bone growth stimulation technologies, and advanced surgical tools, aimed at improving patient mobility and outcomes. Orthofix is committed to addressing various bone and soft tissue conditions through continuous innovation, clinical research, and a dedication to sustainability and community involvement.

📋 Description

• Independently manage a portfolio of high-priority and complex claims requiring advanced solutions and strategies. • Analyze denials, overpayments and underpayments to determine root cause; execute appropriate action plans including appeals, escalations and payer outreach. • Submit technical, clinical and medical necessity appeals at all levels (including external reviews) with supporting documentation. • Research payer contract language, LCD/NCD guidelines and policy updates; apply findings to claims resolution and communicate relevant changes to peers and leadership. • Identify payer trends (example, systemic rejections, denials, overpayments or underpayments) and escalate issues with supporting data to payer contacts and leadership. • Resolve escalated issues involving prepay audits, refund requests, rebills, recoupments and coordination of benefits discrepancies. • Manage HCFA returns and claim corrections, ensuring clean resubmission per billing guidelines. • Communicate effectively with leadership and cross-functional teams to resolve multifaceted claim barriers. • Ensure account documentation is accurate, detailed, and audit ready across all internal system. • Consistently meet or exceed departmental metrics related to productivity, quality, aging resolution, and cash recovery.

🎯 Requirements

• Minimum 2+ years of medical collection or revenue cycle experience with emphasis on post-billing DME or orthopedic claims. • Advanced knowledge of payer guidelines, revenue cycle management, and appeals processes (Medicare, Medicare advantage, Medicaid, and commercial insurance payers). • Proficiency in reading and interpreting EOBs, payer policies, LCDs, and prior authorization requirements. • Strong working knowledge of ICD-10, HCPCs and billing procedures for CMS-1500 claim forms. • Proficient in Microsoft Office and medical billing platforms. • Demonstrated experience with complex denials, payer escalations, and appeals at all levels. • Strong attention to detail with the ability to identify trends and implement corrective strategies. • Excellent communication skills and negotiation skills with payers and internal stakeholders. • Ability to work independently, Detail-oriented with a focus on accuracy, time-management and compliance. • Familiarity with Oracle or similar revenue cycle platforms.

🏖️ Benefits

• Competitive salary • Health insurance • 401(k) matching • Flexible working hours • Paid time off • Professional development opportunities