Accounts Receivable Insurance Reimbursement Specialist

REPORTS TO: Accounts Receivable Team Lead and Director, Revenue Cycle Management

JOB SUMMARY: Ability to identify reimbursement trends, maximize revenue, and maintain Revenue Integrity. Follow up on rejected claims and under payments using Practice Management software, and carrier websites.  Builds and fosters relationships with Provider Representatives. Keeps current with Payer guidelines and Clinical policies.


•           High school diploma required

•           College education or trade school preferred


•           Minimum 1-year experience working in a physician group practice Billing Department

•           Certified Professional Coding designation helpful.

•           Working knowledge of CPT and ICD10-CM coding for Orthopaedic surgery,

            PT, OT and Chiropractic service preferred.

•           Comfortable using email and interacting with Internet applications

•           Knowledge of practice management and word processing software

•           Able to establish good relationships with insurance carriers

•           Good analytical skills and an affinity for detail

•           Ability to read and analyze Accounts Receivable and Task Management reports

•           Pleasant speaking voice and demeanor

•           Neat, professional appearance

•           Professional written and verbal communication skills

Essential responsibilities include, but are not limited to:

Account Follow Up

•           Works collaboratively with Front, Mid-cycle, and Back End Revenue Cycle Teams to streamline processes, and identify gaps in workflow that are impacting claims processing and payment.

•           Follows up on rejected claims the day that the rejected EOB is received   

     •           Using data from the monthly aged Accounts Receivable report, contacts Payers or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system “notes”

•           Maintains detailed knowledge of practice management and other computer software as it relates to job functions

•           Makes necessary arrangements for medical records requests, completion of additional paperwork, etc., if payers request this information prior to payment of claims

•           Responds to written and telephone inquiries from insurance companies

•           Manages relationships with personnel from assigned carriers

•           Calls carriers to appeal payments that do not match contractual agreement; notifies Team Lead of carriers for which this is a consistent problem

•           Asks physicians or CPCs to provide appeal language for denials, or to support medical necessity

•           Processes requests for refunds, and submits to Director of Revenue Cycle Management for approval

•           Meets with Accounts Receivable Team regularly to discuss and solve reimbursement and insurance follow up issues


•           Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice

•           Attends regular staff meetings as requested

•           Attends continuing education sessions as requested

•           Performs any additional duties as required by the Billing Department

Supervisory Responsibilities

This job has no supervisory responsibilities.

Qualified candidates should submit their resumes to:

OSG offers a pleasant professional work environment, competitive wages, and comprehensive benefits, including generous paid time off.

Orthopaedic Specialty Group, P.C., is an Equal Opportunity Employer