Medical and Surgical Billing Support Specialist

Responsibilities

• Prepare and submit accurate insurance claims using CPT, ICD-9, ICD-10, and DRG classifications.
• Review medical records and documentation to ensure proper coding and billing accuracy.
• Build, send, and process medical and surgical claims, both paper and electronic.
• Follow up on unpaid or denied claims using effective medical collection strategies while communicating professionally with insurance companies.
• Verify patient insurance coverage and eligibility prior to service delivery.
• Identify areas below reimbursement expectations and provide timely recommendations to resolve issues.
• Work comfortably with EHR/EMR systems and understand credentialing, CAQH, and PQRS requirements.
• Collaborate with healthcare providers to clarify documentation discrepancies and ensure compliance with coding guidelines.
• Stay current with industry regulations, ICD coding updates, and medical billing best practices.

Qualifications

• Proven experience in medical billing, coding, or related healthcare administration roles, especially surgical and medical services.
• Strong knowledge of ICD-9, ICD-10, CPT, and DRG classifications used in hospital and ambulatory surgical center billing.
• Preferred background in general orthopaedic, orthopaedic spine, or surgical billing and coding.
• Knowledge of insurance contracts, CMS and managed care guidelines, NCCI edits, medical terminology, and medical compliance.
• Familiarity with medical records management and healthcare documentation standards.
• Experience with EMR/EHR systems and other medical office software platforms.
• Understanding of insurance claim procedures, denials management, and collection strategies.
• Strong appeals experience with the ability to successfully appeal unjust denials.
• Ability to interpret complex medical documentation accurately and apply coding conventions.
• Strong organizational skills with attention to detail and the ability to prioritize tasks effectively.

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance