ASC Claims and Billing Specialist

Job Summary

The ASC Back End Claims & Billing Specialist is responsible for the final stage of the revenue cycle, ensuring surgical claims are accurately submitted, authorized, and reimbursed. This role focuses on maximizing revenue by managing the entire denied claims process, submitting appeals, and verifying authorizations to minimize write-offs.

Key Responsibilities

1. Claims Submission & Management

• Review, edit, and submit accurate CMS-1500 or UB-04 claims for ASC surgical procedures to commercial and government payers.
• Verify that all surgical charges, implants, supplies, and medications are captured and coded correctly with appropriate modifiers.
• Utilize claim scrubbing software to ensure "clean claims" and reduce initial rejections.
• Track claim status daily, ensuring timely follow-up.

2. Authorization Verification (Back-End Focus)

• Verify pre-authorization for surgical cases prior to final claim submission, ensuring authorized CPT codes match performed procedures.
• Work with clinical staff to obtain retro-authorizations when procedures change in the OR.
• Identify authorization gaps and work with insurers to resolve them before denial.

3. Denials Management & Appeals

• Analyze, research, and resolve insurance denials by determining root causes (e.g., medical necessity, authorization, coding errors).
• Prepare and submit formal appeals, including drafting letters and gathering necessary clinical documentation.
• Follow up on pending appeals to ensure timely resolution.
• Maintain a high success rate of reversing denials, specifically for high-value surgical cases.

4. Accounts Receivable & Reimbursement

• Review and follow up on aging accounts receivable (A/R) for assigned payers.
• Verify insurance payments and contractual adjustments against expected reimbursement.
• Initiate collections activity for overdue accounts, including communicating with insurance carriers, patients, or responsible parties.

Required Skills & Qualifications

• Experience: Minimum of 2–3 years of dedicated medical billing experience within an Ambulatory Surgical Center (ASC), hospital outpatient setting, or surgical practice.
• Expertise: Deep knowledge of ASC-specific billing (CMS-1500/UB-04), CPT/ICD-10 coding, and complex modifier usage (e.g., -50, -59, -73, -74).
• Authorization Knowledge: Strong understanding of payer authorization requirements and denial resolution.
• Systems: Proficiency in EHR/billing software (e.g., AdvantEdge, SIS/Vision, Epic, eClinicalWorks) and Microsoft Office Suite.
• Soft Skills: Strong analytical, problem-solving, and communication skills to handle complex insurer denials.
• Active Credentials as a Certified Coder preferred

Join our team as an ASC Claims and Billing Specialist if you're eager to leverage your coding expertise, streamline revenue cycles, and contribute to delivering exceptional patient care through precise financial operations. Your dedication will help ensure our organization remains compliant, efficient, and focused on providing outstanding healthcare services.

Pay: $25.00 - $34.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Application Question(s):

• Do you have certification from an accredited coding program?

Education:

• Associate (Preferred)

Work Location: In person