Patient Account Rep - Surgery
Jacksonville Orthopaedic Institute, Jacksonville, Florida, United States, 32201
Patient Account Representative - Surgery
Jacksonville Orthopaedic Institute is looking for a Patient Account Representative - Surgery to join our team at the San Marco office. The position is full-time with benefits including medical, dental, vision, life and disability insurance, and 401K retirement plan. The Patient Account Representative is responsible for accurate billing, follow-up, and resolution of surgical claims. This role ensures that surgical services are coded, submitted, and reimbursed appropriately while maintaining compliance with payer guidelines and supporting revenue integrity. The position requires close collaboration with clinical staff to obtain complete documentation and resolve claim issues efficiently. Work accounts receivable accounts vis workflow established by Patient Account Team Lead. Location: 1325 San Marco Blvd. Jacksonville, FL 32207 Schedule: Monday- Friday Essential Duties and Responsibilities
Surgical Claims Billing
Submit claims for surgical procedures to insurance carriers in a timely and accurate manner. Ensure correct assignment of CPT, ICD-10, and modifier coding based on operative reports and provider documentation. Review surgical charges for completeness and accuracy prior to claim submission. Identify missing or inconsistent documentation and request corrections as needed. Surgical Claims Follow-Up
Monitor the status of submitted surgical claims and ensure prompt payment. Investigate unpaid, underpaid, or delayed claims. Resolve denials by reviewing payer feedback, correcting errors, and submitting appeals or corrected claims when appropriate. Post appropriate adjustments according to contractual guidelines and payer policies. Escalate complex reimbursement issues to leadership when necessary. Collaboration and Communication
Work closely with surgeons, surgical assistants, coders, and clinical staff to obtain complete and compliant documentation. Communicate documentation deficiencies clearly and professionally to clinical teams. Partner with internal departments (coding, authorizations, front desk, and financial counseling) to ensure clean claims and prevent future denials. General Account Management
Maintain accurate patient and insurance information in the practice management system. Document all claim activity and payer communications clearly and consistently. Adhere to productivity, quality, and compliance standards. Maintain knowledge of payer policies, surgical billing rules, and regulatory requirements. Qualifications
Education & Experience
High school diploma or equivalent required; associate degree preferred. Minimum 4 years of medical billing experience, with surgical billing strongly preferred. Orthopaedic or surgical specialty experience preferred. Knowledge & Skills
Working knowledge of CPT, ICD-10, and modifier usage for surgical procedures. Coding certification a plus Understanding of global periods and surgical billing rules. Strong ability to interpret operative reports and clinical documentation. Experience working surgical denials and appeals. Proficiency in practice management and billing systems (Athena, Epic, etc. preferred). Strong organizational, analytical, and communication skills. Ability to work independently and meet deadlines. Performance Expectations
Maintain high claim acceptance rate with minimal rejections. Meet follow-up and appeal turnaround standards. Maintain quality accuracy standards for coding and billing. Demonstrate professionalism when communicating with clinical and administrative staff. Working Conditions
Normal office environment. Occasional overtime may be required. Physical Demands
Requires sitting and standing associated with a sedentary office environment: 90% Sitting, 5% Walking, 5% Standing. Manual dexterity sufficient to type and operate a computer and office equipment, and to write legibly. Vision sufficient to read standard text and data on computer screens and paper forms. Ability to speak clearly and with the volume required to carry on clear conversations in person and over the phone. Hearing sufficient to carry on clear conversations in person and over the phone.
Jacksonville Orthopaedic Institute is looking for a Patient Account Representative - Surgery to join our team at the San Marco office. The position is full-time with benefits including medical, dental, vision, life and disability insurance, and 401K retirement plan. The Patient Account Representative is responsible for accurate billing, follow-up, and resolution of surgical claims. This role ensures that surgical services are coded, submitted, and reimbursed appropriately while maintaining compliance with payer guidelines and supporting revenue integrity. The position requires close collaboration with clinical staff to obtain complete documentation and resolve claim issues efficiently. Work accounts receivable accounts vis workflow established by Patient Account Team Lead. Location: 1325 San Marco Blvd. Jacksonville, FL 32207 Schedule: Monday- Friday Essential Duties and Responsibilities
Surgical Claims Billing
Submit claims for surgical procedures to insurance carriers in a timely and accurate manner. Ensure correct assignment of CPT, ICD-10, and modifier coding based on operative reports and provider documentation. Review surgical charges for completeness and accuracy prior to claim submission. Identify missing or inconsistent documentation and request corrections as needed. Surgical Claims Follow-Up
Monitor the status of submitted surgical claims and ensure prompt payment. Investigate unpaid, underpaid, or delayed claims. Resolve denials by reviewing payer feedback, correcting errors, and submitting appeals or corrected claims when appropriate. Post appropriate adjustments according to contractual guidelines and payer policies. Escalate complex reimbursement issues to leadership when necessary. Collaboration and Communication
Work closely with surgeons, surgical assistants, coders, and clinical staff to obtain complete and compliant documentation. Communicate documentation deficiencies clearly and professionally to clinical teams. Partner with internal departments (coding, authorizations, front desk, and financial counseling) to ensure clean claims and prevent future denials. General Account Management
Maintain accurate patient and insurance information in the practice management system. Document all claim activity and payer communications clearly and consistently. Adhere to productivity, quality, and compliance standards. Maintain knowledge of payer policies, surgical billing rules, and regulatory requirements. Qualifications
Education & Experience
High school diploma or equivalent required; associate degree preferred. Minimum 4 years of medical billing experience, with surgical billing strongly preferred. Orthopaedic or surgical specialty experience preferred. Knowledge & Skills
Working knowledge of CPT, ICD-10, and modifier usage for surgical procedures. Coding certification a plus Understanding of global periods and surgical billing rules. Strong ability to interpret operative reports and clinical documentation. Experience working surgical denials and appeals. Proficiency in practice management and billing systems (Athena, Epic, etc. preferred). Strong organizational, analytical, and communication skills. Ability to work independently and meet deadlines. Performance Expectations
Maintain high claim acceptance rate with minimal rejections. Meet follow-up and appeal turnaround standards. Maintain quality accuracy standards for coding and billing. Demonstrate professionalism when communicating with clinical and administrative staff. Working Conditions
Normal office environment. Occasional overtime may be required. Physical Demands
Requires sitting and standing associated with a sedentary office environment: 90% Sitting, 5% Walking, 5% Standing. Manual dexterity sufficient to type and operate a computer and office equipment, and to write legibly. Vision sufficient to read standard text and data on computer screens and paper forms. Ability to speak clearly and with the volume required to carry on clear conversations in person and over the phone. Hearing sufficient to carry on clear conversations in person and over the phone.