Description

Why Orthofix? Guided by our organizational values – Take Ownership | Innovate Boldly | Win Together – we collaborate closely with world-class surgeons and other partners to improve people’s quality of life. At Orthofix, we want team members who build relationships and share knowledge, challenge the status quo, and deliver results every day to help us achieve our vision to be the unrivaled partner in Med Tech. Our global team of over 1,600 employees brings to market highly innovative, cost-effective, and user-friendly medical technologies that heal musculoskeletal pathologies for patients and the healthcare professionals who treat them. Looking to change people’s lives? Look no further.JOB PURPOSEThe Specialist II, Health Claims Collections is responsible for resolving complex post-payment and denied DME claims. Operating within a wing-to-wing revenue cycle management team, this role takes ownership of highly escalated accounts, advanced appeals, payer trend analysis, and cross-functional issue resolution. The Specialist II, Health Claims Collections serves as a subject matter resource of junior collectors and assists leadership in driving payer compliance and revenue recovery. ESSENTIAL FUNCTIONS AND RESPONSIBILITIESThe following are the essential functions of this position. This position may be responsible for performing additional duties and tasks as needed and assigned.<ul><li>Independently manage a portfolio of high-priority and complex claims requiring advanced solutions and strategies.</li><li>Analyze denials, overpayments and underpayments to determine root cause; execute appropriate action plans including appeals, escalations and payer outreach.</li><li>Submit technical, clinical and medical necessity appeals at all levels (including external reviews) with supporting documentation.</li><li>Research payer contract language, LCD/NCD guidelines and policy updates; apply findings to claims resolution and communicate relevant changes to peers and leadership.</li><li>Identify payer trends (example, systemic rejections, denials, overpayments or underpayments) and escalate issues with supporting data to payer contacts and leadership.</li><li>Resolve escalated issues involving prepay audits, refund requests, rebills, recoupments and coordination of benefits discrepancies.</li><li>Manage HCFA returns and claim corrections, ensuring clean resubmission per billing guidelines.</li><li>Communicate effectively with leadership and cross-functional teams to resolve multifaceted claim barriers.</li><li>Ensure account documentation is accurate, detailed, and audit ready across all internal system. </li><li>Consistently meet or exceed departmental metrics related to productivity, quality, aging resolution, and cash recovery.</li></ul>MINIMUM QUALIFICATIONSThe requirements listed below are representative of the education, knowledge, skill and/or ability required for this position.Education/Certifications:<ul><li>High School Diploma or Equivalent Experience</li></ul>Experience, Skills, Knowledge and/or Abilities:<ul><li>Minimum 2+ years of medical collection or revenue cycle experience with emphasis on post-billing DME or orthopedic claims.</li><li>Advanced knowledge of payer guidelines, revenue cycle management, and appeals processes (Medicare, Medicare advantage, Medicaid, and commercial insurance payers).</li><li>Proficiency in reading and interpreting EOBs, payer policies, LCDs, and prior authorization requirements.</li><li>Strong working knowledge of ICD-10, HCPCs and billing procedures for CMS-1500 claim forms.</li><li>Proficient in Microsoft Office and medical billing platforms.</li><li>Demonstrated experience with complex denials, payer escalations, and appeals at all levels.</li><li>Strong attention to detail with the ability to identify trends and implement corrective strategies.</li><li>Excellent communication skills and negotiation skills with payers and internal stakeholders.</li><li>Ability to work independently, Detail-oriented with a focus on accuracy, time-management and compliance.</li><li>Familiarity with Oracle or similar revenue cycle platforms.</li></ul>PREFERRED QUALIFICATIONSThe education, knowledge, skills and/or abilities listed below are preferred qualifications in addition to the minimum qualifications stated above.Education/Certifications:<ul><li>Associate’s degree preferred</li></ul>Additional Experience, Skills, Knowledge and/or Abilities:<ul><li>N/A</li></ul>PHYSICAL REQUIREMENTS / ADVERSE WORKING CONDITIONSThe physical requirements listed in this section include but are not limited to the motor/physical abilities, skills, and/or demands required of the position in order to successfully undertake the essential duties and responsibilities of this position. In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to allow qualified individuals with a disability to perform the essential functions and responsibilities of the position.<ul><li>No additional physical requirements or essential functions for this position.</li></ul>DISCLAIMERThe duties listed above are intended only as representation of the essential functions of this position. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position. The job description does not constitute an employment agreement between the employer and employee and is subject to change at the sole discretion of the employer. Nothing in this document alters an employee’s at-will employment status<h1></h1>DISCLAIMER The duties listed above are intended only as representation of the essential functions of this position. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position. The job description does not constitute an employment agreement between the employer and employee and is subject to change at the sole discretion of the employer. Nothing in this document alters an employee’s at-will employment status.We are committed to providing equal employment opportunities to all employees and applicants without regard to race (including traits historically associated with race, such as hair texture and protective hairstyles, including braids, locks, and twists), ethnicity, religion, religious creed (including religious dress and grooming practices), color, caste, sex (including childbirth, breast feeding, and related medical conditions), gender, gender identity or expression, sexual orientation, national origin, ancestry, citizenship status, uniform service member and veteran status, marital status, pregnancy, age (40 and over), protected medical condition (including cancer and genetic conditions), genetic information, disability (mental and physical), reproductive health decision-making, medical leave or other types of protected leave (requesting or approved for leave under the Family and Medical Leave Act or the California Family Rights Act), domestic violence victim status, political affiliation, or any other protected status in accordance with all applicable federal, state, and local laws.This policy extends to all aspects of our employment practices including, but not limited to, recruiting, hiring, discipline, termination, promotions, transfers, compensation, benefits, training, leaves of absence, and other terms and conditions of employment.

Health Claims Collections, Specialist II

Description

Orthofix International