The Revenue Operations Specialist plays an important role in TOA’s revenue cycle operations. The role is essentially a liaison between the clinics in which we serve our patients, and our centralized revenue cycle operations. Based in one of our clinics, the Revenue Operations Specialist identifies and resolves outstanding and charges, utilizing expertise in revenue cycle and working to reduce outstanding billing loads and increase TOA productivity. This position reports to the site manager, but will have a great deal of interaction with our Central Business Office and all TOA clinics.

The Revenue Operations Specialist focuses on outstanding charges and cases. Specifically, they will:

• Manage and complete the a daily accounting of unapplied funds, matching the funds to the proper case and reconciling any outstanding issues.
• Research and complete problem issues daily, as outlined in TOA documentation. This will include researching and reconciling insurance denials for various reasons
• Review patient medical records and utilize clinical and regulatory knowledge and skills, as well as knowledge of payer requirements to determine why cases are denied and whether an appeal is required
• Search for supporting clinical evidence to support appeal arguments
• Prepare convincing appeal arguments and submit to the insurance companies
• Prepare and distribute monthly trending data to the management team
• Establish and maintain effective working relationships with physician and staff of various levels at our clinics and Central Business Office
• Operate within established guidelines and protocols, including providing backup documentation for our accounting and audit functions
• Other duties as assigned

At TOA, our patients deserve the best care, and that extends beyond the clinic to include how we handle our business administration activities. The qualifications for this positions include:

• College degree is preferred, and a high school diploma or equivalent is required.
• At least 3 years of experience in health insurance, with experience in payer requirements for reimbursements and denials preferred
• Experience in an orthopaedic practice is a plus
• Demonstrated ability in writing convincing appeals arguments that are sound and supported by evidence that is related to patients’ specific clinical attributes
• Exceptional customer service and patient focus, realizing that our Revenue Operations Specialist may speak with our patients, providers, or payors, and it is essential that they are able to make each encounter as positive as possible.
• Knowledge of administrative and clerical procedures, including experience with computer systems/Excel. Experience with an EHR or NextGen is a plus
• Accustomed to using mostly payer websites for appeals/reconsiderations, medical records attachments, verification of benefits and/or web-based claims follow up
• Collaboration, working closely with Central Business Office and clinical colleagues and administrative team mates to resolve issues
• An energetic and enthusiastic pace at work, with the ability to swiftly and accurately manage the flow documents through our EHR, without any diminishing focus on accuracy
• Dependability, with a reliance on the capacity to be at work on-time, every day so our patients can receive the administrative support they need in a timely manner
• Some travel to various TOA clinics may be required