Billing Procedure Claims Specialist

Billing Procedure Claims Specialist at Summit Spine and Joint Centers. This role processes medical claims for spine and joint procedures, audits claim information, implements coding, and communicates with payers, patients, and providers.

• Audits and ensures claim information is complete and accurate.
• Submits office visit, outpatient procedure, urinary drug screen, DME, MRI, and Chronic Care Management claims.
• Ensures accurate and timely billing of HCFA 1500 claims.
• Documents files with appropriate information (date stamped, logged, signed, etc.).
• Creates logs for providers of pending medical encounters and encounters with errors.
• Works directly with other billing staff and management to meet end‑of‑month closing deadlines.
• Handles clearinghouse rejections, prints, and mails secondaries.
• Addresses inquiries from insurance companies, patients, and providers.
• Understands CPT, ICD
  10, HCPCS coding and modifiers.
• Knows third‑party payers, HMOs, PPOs, Medicare, Medicaid, and Workers’ Compensation.
• Has knowledge of ERAs, EOBs and payer specific/LCD guidelines.
• Understands health plan benefits (deductibles, copays, coinsurance) and eligibility verification.
• Must 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 of 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 required.
• 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.

Full‑time position with competitive salary, PTO, health benefits, and 401(k) match. The ideal candidate will be located in Georgia and be able to work at the administrative office.