Revenue Cycle Specialist

Summary

Florida Orthopaedic Institute is seeking a Revenue Cycle Specialist to manage ancillary billing accounts receivable and maximize reimbursement. The role focuses on claims collection, denial research and appeals, insurance follow-up, billing corrections, and collaboration with internal teams to resolve reimbursement issues.

Responsibilities

• Perform collection activities, including status calls, appeals, and account reviews to ensure timely reimbursement
• Research and resolve claims denials using appropriate internal and external resources
• Monitor denied claims to ensure corrections or appeals are completed accurately and timely
• Review pre-bill claim holds and internal edits to ensure claims are submitted cleanly and timely
• Ensure appropriate and complete information is submitted to insurance companies to expedite payment
• Take proactive follow-up actions to secure payment on the first follow-up call or appeal when possible
• Follow up on assigned cases and work queues within the organization
• Compose and submit appeals to insurance carriers for denied claims
• Handle incoming requests for information from insurance companies within 24 hours
• Assist Financial Counselors with patient inquiries related to claims
• Correct accounts billed to incorrect insurance carriers
• Ensure required authorizations are attached to claims prior to submission
• Meet quantity and quality performance expectations as established by management
• Communicate trends, issues, and findings to the lead, supervisor, and team
• Collaborate with other teams within the business office to resolve billing and reimbursement issues
• Provide appropriate feedback to management regarding process improvements and challenges
• Ensure compliance with all company plans, policies, and procedures set forth by Orthopaedic Solutions Management
• Perform all other duties as assigned

Skills

• Must be able to attend orientation in the Tampa Bay Area
• Must be able to travel to the Tampa Bay area for quarterly meetings
• High School Diploma or GED required
• Strong knowledge of medical claims billing and reimbursement processes
• Ability to read and interpret Explanation of Benefits (EOBs)
• Excellent written and verbal communication skills
• Strong attention to detail and organizational skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficient in basic computer applications and billing systems
• Ability to work independently and collaboratively as part of a team
• Minimum of 2–4 years of medical billing, collections, or denial management experience preferred
• Experience with ancillary billing strongly preferred

Qualifications

Must Haves

• Must be able to attend orientation in the Tampa Bay Area
• Must be able to travel to the Tampa Bay area for quarterly meetings
• High School Diploma or GED required
• Strong knowledge of medical claims billing and reimbursement processes
• Ability to read and interpret Explanation of Benefits (EOBs)
• Excellent written and verbal communication skills
• Strong attention to detail and organizational skills
• Ability to manage multiple priorities in a fast-paced environment
• Proficient in basic computer applications and billing systems
• Ability to work independently and collaboratively as part of a team

Nice to Haves

• Minimum of 2–4 years of medical billing, collections, or denial management experience preferred
• Experience with ancillary billing strongly preferred