The Claims Reconciliation Specialist is responsible for comprehensive billing procedures and verification prior to coding for anesthesia services. This role ensures accurate documentation collection, provider verification, and compliance with medical direction requirements to maximize revenue recovery. This is a full-time position based at our corporate office in Addison, TX, reporting to the Scheduling/Intake/Scrubbing Lead. This role requires on-site presence during regular business hours.
Key Responsibilities
Documentation and Verification
Documentation Collection: Ensure receipt of complete anesthesia records including pre-anesthesia evaluation, intraoperative records, PACU documentation, and addendums
Provider Verification: Confirm all applicable providers are properly identified with supervising and rendering provider details
Case Details Review: Validate date of service, facility information, and cross-check surgeon details against anesthesia records
Time Accuracy Review: Verify anesthesia start/stop times, document breaks and hand-offs, ensure consistency across cases
Compliance and Coding
Medical Direction Compliance: Ensure seven required elements are documented including pre-anesthesia evaluation, presence at induction, monitoring, availability, emergence, post-anesthesia care, and 4:1 supervision ratio
Modifier Verification: Confirm correct ASA status assignment and anesthesia modifiers
Supporting Documentation: Verify documentation supports additional procedure codes for pain blocks, line placement, and ultrasound guidance
Administrative Tasks
Insurance Verification: Confirm patient eligibility and obtain required authorizations
Charge Ticket Review: Ensure anesthesia records align with internal charge tickets
Batch Management: Verify case counts and upload complete batches for data entry team
Required Qualifications
High school diploma or equivalent; associate degree in healthcare administration preferred
2+ years of experience in medical billing, particularly anesthesia billing
Knowledge of CPT, ICD-10, and anesthesia-specific coding (ASA base units, time units, modifiers)
Understanding of medical direction vs. medical supervision billing requirements
Familiarity with CMS guidelines for concurrent care limitations
Proficiency in practice management software and electronic health records
At OrthoMed, you'll be part of a team dedicated to excellence in patient care. We offer competitive compensation, health/dental/vision insurance, 401(k) with 3% non-discretionary company contributions, professional development opportunities, and a fun collaborative work environment.
Join us in our mission to elevate healthcare standards and make a lasting impact. Apply now to become an integral part of our dynamic team!
