Overview
We are seeking a dedicated and detail-oriented Medical and Surgical Billing Specialist to become a vital part of our bustling Orthopaedic Spine healthcare team. As a Medical and Surgical Billing Specialist, you will utilize core skills in medical collection, EMR systems, and medical terminology to ensure accurate and timely billing processes for the clinic and surgical center. In this vital role, you will also be responsible with assisting with the management of collecting outstanding medical accounts, ensuring timely payments, and maintaing positive relationships with patients and insurance providers. With a focus on accuracy and efficiency, your role will involve working with EHR systems and medical records to support the financial health of our organization. Join us in this critical role where your expertise in medical and surgical billing and coding will make a significant impact on our operations.
Responsibilities
- Prepare and submit accurate insurance claims using appropriate coding systems such as CPT (Current Procedural Terminology), ICD-9, ICD-10, and DRG (Diagnosis-Related Group) classifications.
- Review medical records and documentation to ensure proper coding and billing accuracy.
- Build, send, and process medical and surgical claims (paper and electronic)
- Follow up on unpaid or denied claims through effective medical collection strategies while maintaining professional communication with insurance companies.
- Verify patient insurance coverage and eligibility prior to service delivery to facilitate smooth billing processes.
- Apply analytical and critical thinking to determine any areas which fall below reimbursement expectations and provide timely recommendations— to resolve those matters.
- Comfortable with all aspects of EHR/EMR systems. Experience in credentialing, CAQH, and PQRS requirements
- Collaborate with healthcare providers to clarify documentation discrepancies and ensure compliance with coding guidelines.
- Stay current with industry regulations, updates in ICD coding standards, and best practices in medical billing to optimize reimbursement processes.
Qualifications
- Proven experience in medical billing, coding, or related healthcare administration roles with a focus on surgical and medical services.
- Strong knowledge of ICD-9, ICD-10, CPT coding systems, as well as DRG classifications used in hospital/ambulatory surgical center billing. General Orthopaedic and Orthopaedic Spine, and/or surgical billing and coding background is preferred.
- Knowledge of insurance contracts, CMS and managed care guidelines, NCCI edits, medical terminology and medical compliance.
- Familiarity with medical terminology, medical records management, and healthcare documentation standards.
- Experience working with EMR/EHR systems and other medical office software platforms.
- Excellent understanding of insurance claim procedures, denials management, and collection strategies.
- Must have in-depth knowledge of the appeals process and ability to successfully appeal unjust denials
- Ability to interpret complex medical documentation accurately and apply appropriate coding conventions.
- Provide excellent customer service by addressing patient inquiries professionally and empathetically while explaining billing processes clearly.
- Assessment of payments to ensure compliance with contractual agreements, Medicare allowable, workers compensation fee schedules, etc.
- Maintain detailed documentation of collection efforts, payment statuses, and communication logs within billing software and EMR/EHR platforms for attorney intervention.
- Prepare and send collection demand documentation.
- Strong organizational skills with attention to detail and the ability to prioritize tasks effectively.
Requirements
- Proven experience in medical office settings with a focus on medical billing, and collections
- Strong knowledge of medical and surgical claims management, including familiarity with DRG, CPT coding, ICD-9/ICD-10, and ICD coding standards
- Proficiency in Microsoft Office applications (Word, pdf documents, and Excel), billing software, EMR/EHR systems, and other healthcare technology tools
- Understanding of health insurance policies, medical terminology, and medical records management
- Excellent and efficient communication skills with a customer service-oriented approach when discussing collection matters with patients and insurance companies.
- Ability to work independently while managing multiple accounts efficiently
- Attention to detail with strong organizational skills to ensure accuracy in all documentation
- Proficiency in drafting, editing, and finalizing correspondence.
Join our team as a Medical and Surgical Billing Specialist to ensure precise financial operations that support quality patient care while fostering professional growth within a dynamic healthcare environment!
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person
