Orthopedic Revenue Cycle Consultant – GHI/Emblem Health Imaging Reimbursement Specialist

A growing orthopedic practice in New York is seeking an experienced Revenue Cycle Consultant with extensive expertise in GHI/Emblem Health claims processing to resolve ongoing reimbursement issues involving diagnostic imaging services.

We are specifically looking for an individual who has successfully navigated the GHI/Emblem Health transition to UnitedHealthcare claims administration, understands New York commercial payer reimbursement, and has a proven track record of recovering significant imaging revenue.

Scope of Work:

• Perform a comprehensive analysis of imaging claim denials, underpayments, and payment delays.
• Identify the root causes of reimbursement issues affecting MRI, X-ray, ultrasound, fluoroscopy, and other diagnostic imaging services.
• Review payer edits, CPT coding, modifiers, medical necessity requirements, and reimbursement policies.
• Audit claim submission workflows from registration through payment posting.
• Review ERA/EOB data to identify systemic payment errors and recurring denial patterns.
• Develop and implement corrective workflows to improve clean claim rates and reimbursement.
• Assist with high-value appeals, payer escalation, and recovery of outstanding accounts receivable.
• Provide written recommendations and train staff on best practices to prevent future payment issues.

Qualifications:

Required

• 5+ years of experience in orthopedic or radiology revenue cycle management.
• +Expert knowledge of GHI/Emblem Health claim processing and reimbursement.
• Direct experience with the UnitedHealthcare administration of GHI/Emblem Health claims, including claim routing, payer edits, reimbursement methodologies, and appeals.
• Extensive knowledge of CPT coding, ICD-10-CM, HCPCS modifiers, NCCI edits, and diagnostic imaging billing.
• Experience analyzing ERA files, denial trends, and payment variances.
• Demonstrated success recovering substantial payer reimbursements.

Preferred

• CPC, CPB, RHIA, RHIT, or similar certification.
• Experience with Modernizing Medicine (ModMed), TriZetto, Waystar, or similar practice management and clearinghouse platforms.
• Experience working with New York physician groups, orthopedic practices, imaging centers, or ambulatory surgery centers.

Deliverables:

The selected consultant will be expected to:

• Identify the specific causes of payment failures.
• Quantify financial exposure and recovery opportunities.
• Recover unpaid and underpaid claims whenever possible.
• Develop a sustainable workflow to prevent recurrence.
• Provide a final written report with recommendations and implementation steps.

We are seeking an experienced problem solver with a documented history of resolving complex GHI/Emblem Health imaging reimbursement issues and improving collections for physician practices. Please include a summary of relevant experience, references, and examples of similar engagements.

EEO Disclosure:

iOrtho is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.