Insurance Settlement Analyst- Charlotte, NC

At OrthoCarolina, our team is our greatest asset and the foundation of our success. We are a diverse group of individuals, accountable to each other to uphold the standards of excellence and promote an environment of teamwork throughout the organization.  OrthoCarolina has 43 unique care locations with over 1300 professionals who share a common goal to make lives better. Our employees are eligible for a full spectrum of benefits including paid company holidays, wellness programs, and tuition reimbursement. To learn more about Team OC please visit https://www.orthocarolina.com/about-us

OrthoCarolina is seeking a detail-orientedInsurance Settlement Analyst to join our BusinessOffice team in a hybrid work environment.

TheInsurance Settlement Analyst is responsible for the daily review of incoming Medicare remittances to identify forwarding balances and process refunds through the Medicare Online Provider System. This role reviews commercial carrier refund requests to determine validity, processes approved requests and prepares appeal letters to dispute inappropriate refund demands. The position also submits corrected claims when necessary to ensure accurate reimbursement and compliance with payer requirements. Success in this role requires strong analytical skills, attention to detail, and a thorough understanding of medical billing, claims processing, and reimbursement practices. The Insurance Settlement Analyst will collaborate with internal stakeholders to resolve billing discrepancies, support revenue cycle initiatives, and maintain accurate financial records.

Essential Functions:

• Maintains a working knowledge of CPT and ICD -10 coding principles, Medicare regulations, protocols and third-party requirements for billing and documentation guidelines.  
• Daily reviews incoming Medicare Remits to identify forwarding balances that need to be electronically refunded to Medicare, set up account refund, and process refund through Online Provider System.  
• Sends corrected claims, if applicable, for any claims affected by Patient Home Health or Skilled Nursing Period.  
• Daily reviews Commercial Insurance Refund requests for validity.  
• Works closely with Insurance carriers and their representatives to resolve refund issues.  
• Reviews, modifies and recommends changes to policies and procedures to improve coding and reimbursement efficiencies.  
• Establishes and maintains a professional working relationship with physicians and staff.   
• Sets up Accounts for refunds, note accounts and forward to accounting for processing.  
• Constructs denial letters for any refunds that were determined were in error, and/or send corrected claim if there is a coding adjustment to be made that would allow for payment of claim.  
• Maintains a positive working relationship with Denial Coordinators and AR Reps, and other members of the Business Services Department, to ensure any team member whose workflow will be affected by refund is notified.  
• Identifies refund trends and creates new strategies to reduce refund requests.
• Follows trends affecting volume of refund request and notify management.    

Skills and Abilities:

• Knowledge of Medicare Billing Including Skilled Nursing Facility Billing Guidelines required.  
• Knowledge Correct Coding Initiative Guidelines required.  
• Knowledge of CPT/ICD-10 Coding principles required.    
• Effective written and verbal communication skills.  
• Some knowledge of medical terminology.  
• Attention to detail.  

Qualifications:

• High School Diploma or G.E.D.   
• Some college or college degree preferred.  
• Minimum of two years’ experience in a surgical office, hospital, or other health related enterprise with a strong understanding of coding guidelines.    
• Experience using Medicare OPS.    
• Experience with Commercial Insurance Billing, Appeals and Refund process required.  
• Medical Billing Specialist Certification preferred but not required.   
• CPC is highly recommended but not required.  

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