Revenue Cycle Specialist

TSAOG Orthopaedics and Spine

Date: Nov 25, 2022
City: San Antonio, TX
Salary: $17 - $17 / hour
Contract type: Full time
TSAOG Orthopaedics and Spine

Get to know us:

TSAOG Orthopaedics is a large multi-specialty physician group. We have been here since 1947 and we’re not going anywhere. We take a big part in Community outreach with our Light Charity program. If you are looking for a team that enjoys Laughing, is Family orientated, and has the work hard play hard mentality, then this company is for you. We value Respect, Communication, Accountability, Dependability and Compassion. A place where you can rely on great Teamwork and Integrity. We are a place that is true to its values. If this is what you are looking for then look no further.

Summary of position:

We are looking for a sharp, ambitious, and enthusiastic Revenue Cycle Specialist to join our team. The successful candidate is someone that is passionate about working in a care team model with a personal responsibility of providing care for our orthopaedics patients and clinical support to the team. The right candidate will be able to provide an exceptional patient care experience that promotes healing and recovery, and having an attention to detail mindset while being caring and compassionate.

If you’re a people person looking to join an amazing company in the world of Orthopaedics, this is the place for you!

What You’ll Do:

  • Obtains all paperwork required to complete the payment on claims such as dictation, TWCC-73, medical necessity letters, 22-modifer letters, unspecified code letters, etc. for all payors, including worker’s compensation.

  • Assists other team members with the clearance of claims through correction and/or resubmission.

  • Audits claim processing for accuracy in payment amount in accordance with contracts, improper global adjustments, bundling denials, stall techniques, ignorance of modifiers, slow pay, low pay, no pay trends; utilizing a combination of appeal letters, meetings with insurance companies, Bad Faith Letters, Federal tort law, Texas Clean Claim Laws, and reporting to TDI at a minimum to secure proper reimbursement and/or penalties

  • Appeals adverse decisions and uses appropriate course of action to appeal denied or incomplete claims. Methods may include research of patient records (electronic or hard copy), communication with physician/department team members, communication with cross-coders, review of payer website, and/or review of payer contract.

  • Submitting appeals via Portals or via EMR system.

  • Responding to emails assigned to the department on a rotating basis.

  • Obtain authorization and process adjustments resulting in patient or payer overpayment, special discount promotions, etc. as required.

  • Work reports of specific denials provided by the Director, Billing Manager or Team lead,.

  • Work with Department co-workers on special projects as requested by Director, Billing Manager, or Team lead.

  • Communicate with Managed Care companies acting as a liaison representing the Department for all reimbursement issues and good will communications.

  • Follow the requests and directions of department Director, Billing Manager or team lead.

  • Assist Financial counselors with questions, claim corrections and patient issues.

  • Other duties as assigned

What You’ll Need:

  • Must have a High School Diploma or equivalent.

  • Minimum of 5 years experience in management of Practice A/R, reimbursement, coding and insurance, Orthopaedic experience a plus.

  • Planning, organizing, problem-solving and decision making. Must be proficient in Excel and word, and have a high level of comfort around computers and general office equipment.

  • Ability to communicate effectively. Must have leadership capabilities. Ability to plan and organize with limited direction. Ability to develop and maintain effective relationships. Ability to scan documents and attach to electronic records. Excellent research, follow through and documentation are required.

  • Other duties as assigned as necessary and may vary at times, as needed, by your immediate supervisor or as directed by the company.

  • Requires prolonged sitting, some bending, stooping, and stretching. Requires eye hand coordination and manual dexterity sufficient to operate a keyboard, photocopies, telephone, calculator and other equipment. Requires normal range of hearing and eyesight

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