Billing Procedure Claims Specialist

Billing Procedure Claims Specialist – Mambo Seafood Restaurants

Join to apply for the Billing Procedure Claims Specialist role at Mambo Seafood Restaurants. The position is full‑time with competitive salary, PTO, health benefits, and a 401(k) match. Ideal candidates will be located in Georgia or be able to be present at our administrative office near Austin, Texas, where other members of the billing team are located.

Summit Spine and Joint Centers is a rapidly expanding Pain Management Group looking to add an experienced Medical Billing Specialist to our team. With twelve ambulatory surgery centers and twenty‑three clinic locations across the State of Georgia, Summit Spine is winning the race to become the largest comprehensive spine and joint care provider in the state. We are looking for a motivated and hard‑working Claims Processor who can join our growing team of professionals.

• Audit and ensure claim information is complete and accurate.
• Submit claims for office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management.
• Ensure accurate and timely billing of HCFA 1500 claims.
• Document files with appropriate information (date stamped, logged, signed, etc.).
• Create logs for providers of pending medical encounters and encounters with errors.
• Work directly with other billing staff and management to meet end‑of‑month closing deadlines.
• Work with clearinghouse rejections, print, and mail secondaries.
• Address inquiries from insurance companies, patients, and providers.
• Understand CPT, ICD‑10, HCPCS coding and modifiers.
• Know third‑party payers (HMOs, PPOs, Medicare, Medicaid, Worker's Compensation, etc.).
• Know ERAs, EOBs and payer‑specific / LCD guidelines.
• Understand health‑plan benefits (deductibles, copays, coinsurance) and eligibility verification.
• Be proficient with spreadsheets and word‑processing applications.

• Minimum of 3 years’ experience with medical billing or revenue cycle in a medical setting.
• Experience with Medicare, Medicaid, commercial insurance plans, workers’ comp, and personal injury cases.
• Knowledge of claims submission for office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management.
• Knowledge of medical billing rules, such as coordination of benefits, modifiers, and understanding of EOBs and ANSI code denials.
• Excellent knowledge of CPT coding, ICD‑10 coding and medical pre‑certification protocols.
• Excellent computer skills and familiarity with Microsoft Office.
• Comfortable working in a growing, dynamic organization and able to navigate change.
• Self‑motivated with ability to multi‑task, prioritize work in a fast‑paced, team environment.
• Bachelor’s degree preferred.
• Experience using eClinical
  
  Works preferred.
• Experience with high‑level procedure billing and coding for pain management preferred.

Mid‑Senior Level

Full‑time

Accounting/Auditing and Finance

Food and Beverage Services