Medical Billing Specialist

Job Description

Title: Medical Billing Specialist

Location: 1111 Leffingwell Ave. NE, Grand Rapids, MI 49525 (Candidates must live in Michigan or plan to relocate.)

Hours: Typical schedule is 8:00AM-5:00PM, Monday-Friday (After training, there is the potential to work 4 10's)

Work Environment: Remote (Will be expected to report to above address for training and come onsite for meetings as requested.)

About Us

Orthopaedic Associates of Michigan (OAM) is proud to be West Michigan’s most established orthopaedic practice. Our physicians and team members provide exceptional, individualized care for patients of all ages. As the most comprehensive independent provider of musculoskeletal care in the region, we provide total care from diagnosis, to treatment, and all the way through rehabilitation. 

Patients at OAM will have access to our Specialized Surgeons, Physical and Occupational Therapists, MRI and X-ray services, and orthopaedic bracing. Patients are also able to receive care from our Bone Health Clinic, OAM Now Urgent Orthopaedic Care Clinic, and Surgery Center at MidTowne – all of which are committed to optimizing their treatment outcomes. 

Our teams work together to maximize and adjust treatment quickly and easily, resulting in a smoother, faster recovery for patients. From neck to toe, and from traumatic injuries to chronic conditions, patients will receive compassionate care that will allow them to embrace their full potential. Patient goals are our goals – we will restore their health so they are functioning as fully as possible in the activities they love at home, work, and in everyday life.

Position Summary

As the Billing Specialist at OAM, you will be responsible for managing the administrative responsibilities of billing insurance and processing payments for the practice, which includes office visits, surgeries, injections, x-rays, etc.. You will work closely with patients and third-party billers to ensure that all claims have been processed correctly and paid in a timely matter. A detail-oriented and analytical mindset will be key to helping you succeed in this role.

Essential Responsibilities

• Answer incoming calls to the billing department in a prompt and courteous manner.
• Research account balances for patients and assist with payment resolution.
• Verify patients’ insurance coverage and update any changes in their charts.
• Process refund forms for overpaid accounts.
• Communicate with payers to appeal payments that do not match contractual agreements.  
• Identify, track, and resolve overdue insurance balances using NextGen tasking system.
• Post all payments by line item in a timely and accurate manner. Balance transactions at the completion of each batch.  
• Identify all payments and rejections that weren't processed correctly or according to contract for further action. 
• Resubmit insurance claims as necessary with all supporting documentation.
• Create secondary claims in NextGen and forward the explanation of benefits to insurance claims processing staff.  
• Print and forward all EOB's that have been identified as not paid per contract or require additional information and research to appropriate insurance collectors.
• Prepare and submit professional appeal letters to insurance payers on claims rejected or paid incorrectly.
• Work with insurance companies to identify payments that were received without explanation of benefits or are not identifiable.
• Respond to inquiries from insurance carriers.
• Manage relationships with staff from assigned insurance carriers.
• Maintain patient confidentiality; comply with HIPAA and compliance guidelines established by the practice. 
• Performs other duties or functions as assigned.

Required & Preferred Qualifications

Education, Training, and Experience:

• Required:
  1. 1+ years of medical billing experience.
  2. Experience working in EMR/EHR systems and third-party payment portals.
  3. High School Diploma/GED
• Preferred:
  1. Bachelor’s degree in business or related field.
  2. Experience working with PT/OT/DME billing.
  3. Experience working in NextGen.

Specific Skills, Knowledge, and Abilities:

• Excellent verbal and written communication skills.
• Ability to easily and efficiently pull reports from various computer applications.
• Integral knowledge of accounts receivable and point-of-service patient collections.
• Knowledge of CPT/ICD-10 coding.
• Ability to multitask and remain detail-oriented when working in fast-paced environment.
• Microsoft Office and Windows based applications knowledge.

Motor, Sensory, and Physical Requirements:

• Ability to sit for long periods of time.
• Manual dexterity required to operate modern office equipment.
• Occasional bending, stooping, lifting (of up to 50 lbs), and reaching may be required.
• Normal or correctable range of hearing and eyesight.

Remote Requirements:

• Clearly defined workspace equipped with desk, chair, surge protector, and high speed internet.
• Employee agrees that OAM equipment will not be used by anyone other than the employee and only for business related work. The employee will not make any changes to security or administrative settings on OAM equipment. The employee understands that all tools and resources provided by the company shall remain the property of the company at all times.
• The employee will report any internet or power outages to supervisor and make appropriate temporary work arrangements for completing work duties.