As an Orthopedic Billing Specialist with Direct Orthopedic Care, you will review, process, and follow up on medical encounters to ensure accurate and timely billing. This role supports a service-driven healthcare organization focused on claims accuracy, documentation quality, and efficient reimbursement.
Key responsibilities include:
- Review clinical notes, operative reports, and supporting documentation to verify billed services
- Validate CPT/HCPCS and ICD-10-CM codes, modifiers, diagnosis sequencing, and diagnosis pointers
- Evaluate coding edits and escalate documentation or coding questions before claim submission
- Verify insurance details, provider information, and required authorizations or cosignatures
- Prepare and process insurance, workers’ compensation, LOP, self-pay, surgery, DME, and special encounter billing
- Submit electronic claims and resolve clearinghouse rejections
- Monitor billing queues for unsubmitted, delayed, or missed encounters
- Apply charges, discounts, adjustments, and payments according to policy and authorization limits
- Document claim reviews, corrections, communications, and follow-up actions
- Communicate with providers and internal departments to resolve billing barriers
- Follow SOPs, protect confidential information, and participate in training and quality improvement
Requirements & Qualifications
Qualifications
- High school diploma or equivalent
- Minimum 2 years of medical billing experience
- At least 1 year of orthopedic billing experience
- Workers’ compensation billing knowledge or experience
- Working knowledge of CPT/HCPCS, ICD-10-CM, modifiers, coding edits, clinical documentation review, and health insurance billing processes
- Ability to interpret payer requirements and contractual billing provisions
- Ability to use practice management and electronic medical record systems
- Active CPC certification preferred
Location
Texas, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago
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