Medical Billing Claims Specialist

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.

• Audit and ensure claim information is complete and accurate.
• Process claims submission for office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management.
• Accurately and timely bill HCFA 1500 claims.
• Document files with appropriate information (e.g., date‑stamped, logged, signed).
• Create logs for providers of pending medical encounters or encounters with errors.
• Work with other billing staff and management to meet end‑of‑month closing deadlines.
• Handle clearinghouse rejections, print, and mail secondaries.
• Address inquiries from insurance companies, patients, and providers.
• Apply knowledge of CPT, ICD‑10, HCPCS coding and modifiers.
• Understand third‑party payers such as HMOs, PPOs, Medicare, Medicaid, and Worker’s Compensation.
• Use ERAs, EOBs, and payer‑specific/LCD guidelines.
• Understand health plan benefits (deductibles, copays, coinsurance) and eligibility verification.
• 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.
• Familiarity with 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 Pain Management preferred.

The position is full‑time with competitive salary, PTO, health benefits, and 401(k) match. The ideal candidate will be located in North Carolina.