Medical and Surgical Billing Specialist

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. 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.
• Strong organizational skills with attention to detail and the ability to prioritize tasks effectively.

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