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.
Responsibilities:
- 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.
- 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 resolve them with insurers before denial.
- Analyze, research, and resolve insurance denials by determining root causes.
- 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 for high-value surgical cases.
- Review and follow up on aging accounts receivable 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.
Qualifications:
- Minimum of 2–3 years of dedicated medical billing experience within an Ambulatory Surgical Center (ASC), hospital outpatient setting, or surgical practice.
- Deep knowledge of ASC-specific billing (CMS-1500/UB-04), CPT/ICD-10 coding, and complex modifier usage.
- Strong understanding of payer authorization requirements and denial resolution.
- Proficiency in EHR/billing software such as AdvantEdge, SIS/Vision, Epic, eClinicalWorks, and Microsoft Office Suite.
- Strong analytical, problem-solving, and communication skills.
- Active credentials as a Certified Coder preferred.
This position is on-site in Creve Coeur, MO.
Pay is $25.00 - $34.00 per hour.
Benefits include 401(k) matching, dental insurance, health insurance, paid time off, and vision insurance.
Requirements & Qualifications
- 2–3 years medical billing experience specifically in Ambulatory Surgical Center, hospital outpatient, or surgical practice
- Knowledge of CMS-1500/UB-04 claims
- Proficient with CPT/ICD-10 coding and complex billing modifiers
- Understanding of payer authorization and denial management
- Proficiency with EHR/billing software and Microsoft Office
- Certified Coder credentials preferred
- Associate degree preferred
Benefits & Perks
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Location
Missouri, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 week ago