Since 1969, OCR has been local and physician-owned with strong ties to the community. With talented, hardworking, and friendly staff, we work toward the common goal of serving residents of CO, WY, and NE with specialty-focused care. We are experiencing tremendous growth and are adding talented people in all of our locations!
The Therapy Biller acts as a liaison between the Medical Billing, Insurance Coordinator, and Therapy teams to identify and research insurance claim rejections associated with physical and occupational therapy. This position takes part in ongoing education, performs research into insurance payer policies and guidelines, and is responsible for communicating changes to insurance policies, maintaining up-to-date reference materials, and ensuring compliance with all insurance rules and regulations. Additionally, this position provides support for the Insurance Coordinator team in researching rejected claims to determine the appropriate internal procedure for correcting, refiling and performing follow-up as applicable.
To perform this job successfully, an individual must have the education and experience identified below and be able to perform each essential duty and responsibility satisfactorily, either with or without a reasonable accommodation. The below is intended to describe the general content of and requirements for the performance of this job and is not to be construed as an exhaustive statement of essential functions, responsibilities or requirements.
Essential Duties and Responsibilities
- Maintains thorough understanding and up-to-date reference materials on respective insurance rules and regulations to ensure compliance.
- Communicates changes to respective insurance policies to supervisor and aids in dissemination of updates to appropriate staff.
- Responsible for planning and leading cross-departmental training related to Physical and Occupational Therapy billing rules and requirements within the Business Office and Therapy departments.
- Obtains a general understanding of insurance carriers assigned to other insurance coordinators and communicates changes and/or adjustments needed.
- Routinely audits coding and demographical data on visit tickets to ensure accuracy of claims.
- Enters charges for practice, surgery and receipts as required.
- Follows up on denials, claim suspensions, and severe reductions in reimbursement promptly, exercise all options to obtain payment.
- Responds to insurance carrier requests for information in a prompt and professional manner.
- Prepares adjustments, as needed, for accounts and submits completed adjustment batches to the supervisor for weekly approval.
- Completes assigned special projects involving large-scale payer issues and claim resolution as needed.
- Communicates all concerns, risk management issues, breakdown in protocol and constructive criticisms to supervisor. Follows chain-of-command established by supervisor when addressing protocol issues outside of business office department.
- Maintains a clean and orderly work area.
- Required to follow OCR as well as departmental policies and procedures.
- Other duties as assigned.
Education and Experience
- High school diploma or equivalent is required.
- Minimum one year experience in the insurance or medical industry or equivalent experience with collections in a business/accounting department.
- Knowledge of medical terminology preferred
Certificates, Licenses, Registration
- Quality - Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality; applies feedback to improve performance; monitors own work to ensure quality.
- Detail Oriented - Consistently checks and rechecks work product for accuracy; able to manage multiple tasks while accurately performing essential job functions; prepares accurate and thorough reports, emails, and data as required by the position.
- Oral and Written Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; writes clearly and informatively; edits work for spelling and grammar; able to read and interpret written information; able to communicate with patients and coworkers.
- Teamwork - Balances team and individual responsibilities; puts success of team above own interests; Able to build morale and group commitments to goals and objectives; supports everyone's efforts to succeed.
- Confidentiality - Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy. Adheres to HIPAA guidelines.
Independence of Action
Work is closely monitored by supervisor/manager; detailed instructions and procedures are generally provided.
This job has no supervisory responsibilities.
Position requires acceptable motor vehicle driving history, valid and free from restrictions, and must have a valid driver’s license and appropriate vehicle insurance coverage. Ability to travel between all OCR locations.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
(The phrases “occasionally”, “regularly”, and “frequently” correspond to the following definitions: “occasionally” means up to one-third of working time, “regularly” means between half and two-thirds of working time, and “frequently” means two-thirds and more of working time.)
- The work environment is the typical office environment. The employee must be able to complete their work satisfactorily in an environment where there are significant distractions, including staff, patients, and vendors walking through and conversing, telephones ringing, conversations carrying over, loud noises, and interruptions to answer questions from others.
- While performing the duties of this job, the employee is frequently required to sit and use hands to finger, handle, or feel objects, tools, or controls up to 8 hours per day. The employee frequently is required to talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms, and stoop, kneel, crouch, or crawl.
- The employee will occasionally lift and/or move up to 25 pounds and should do so in a sound and safe manner. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
- Medical, Dental, Vision coverage
- Life and AD&D Insurance
- Short Term and Long Term Disability Insurance
- Retirement savings and profit sharing plan participation
- Employee Assistance Program
- Continuing Medical Education (depending on position)
- Paid Time Off
*Benefit eligibility is dependent on employment status, and a waiting period may apply.
Orthopaedic & Spine Center of the Rockies (OCR) is an Equal Opportunity Employer and prohibits discrimination or harassment of any kind. OCR is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions are based on business needs, job requirements and individual experience and qualifications, without regard to a person's race, color, age, sex, gender identity, gender expression, marital status, sexual orientation, religion, creed, national origin, the presence of any physical or mental disability, or status as a disabled veteran, recently separated veteran, other protected veteran, or Armed Forces service medal veteran, or any other protected status