Billing & Coding Specialist Revenue Cycle Team

Revive Orthopedics; United States; Hybrid; USD 42,000 - 66,000; Full time

Job summary

Revive Orthopedics seeks a Billing & Coding Specialist to manage coding, billing, and denial management across orthopedic services.

You will assign ICD-10-CM and CPT/HCPCS codes, submit claims, review edits, verify eligibility, and monitor A/R while ensuring compliance with HIPAA and payer requirements. The role offers hybrid work with onsite training.

Qualifications

• Requires 2+ years of medical billing and coding experience in a physician practice.
• Proficiency with CPT, ICD-10-CM, HCPCS, and modifiers is needed.
• Familiarity with payer rules, EOBs/ERAs, and denial management is essential.
• Experience with a practice management/EHR system and Excel is preferred.

Responsibilities

• Review clinic notes, operative reports, and documentation to assign ICD-10-CM, CPT, and HCPCS codes.
• Enter charges and submit claims within timely filing limits.
• Review claim edits and resubmit after corrections.
• Verify insurance eligibility, authorizations, and referrals as needed.
• Post payments and resolve discrepancies; monitor A/R and denials.

Skills

Analytical thinker

Detail-oriented

Team collaboration

Communication skills

Education

High school diploma or equivalent

Tools

Practice management/EHR system

Microsoft Excel

Job description

Position: Billing & Coding Specialist Revenue Cycle Team

Department: Revenue Cycle Management

Reports to: Revenue Cycle Director

Position Summary

The Billing & Coding Specialist is responsible for accurately assigning diagnosis and procedure codes for orthopedic services and managing the claim lifecycle from charge entry through payment posting and follow-up. This role works closely with providers, surgery schedulers, prior authorization staff, and front office teams to maximize clean claim rates, reduce denials, and support compliant, timely reimbursement.

Key Responsibilities

Coding

• Review clinic notes, operative reports, and procedure documentation to assign accurate ICD-10-CM, CPT, and HCPCS codes.


• Apply appropriate modifiers (e.g., -RT/-LT, -50, -51, -59, -62, -78, -79, -24, -25, -57) and global period rules.


• Code orthopedic services including E/M visits, fracture care, joint injections, DME dispensing, in-office procedures, imaging, and surgical cases.


• Ensure documentation supports medical necessity and coding level; query providers when documentation is incomplete or unclear.


• Stay current on CPT/ICD-10 updates, NCCI edits, and payer-specific coding policies.

Billing & Claims Management

• Enter charges and submit claims accurately and within timely filing limits.


• Review and resolve claim scrubber edits and rejections before submission.


• Verify insurance eligibility, authorizations, and referrals as needed for surgical and high-cost services.


• Bill for implants, bracing, DME, and ancillary services per payer requirements.


• Maintain audit documentation.

Denials, Follow-Up & Payment Posting

• Work denials and underpayments, prepare appeals, and track outcomes in a timely manner.


• Follow up on unpaid claims with commercial payers, Medicare, Medicaid, workers' compensation, and auto/liability carriers.


• Post payments, adjustments, and ERAs/EOBs, resolving any discrepancies.


• Identify denial trends and recommend process or documentation improvements.

Patient Accounts & Communication

• Respond to patient billing inquiries professionally and in a timely manner.


• Set up payment plans and assist with financial assistance processes per policy


• Coordinate with front desk and clinical staff to resolve registration, authorization, and documentation issues

Compliance & Quality

• Adhere to HIPAA, Medicare/CMS regulations, and internal compliance policies.


• Participate in coding audits and implement corrective actions.


• Meet established productivity, accuracy, and A/R targets.

Qualifications

Required

• High school diploma or equivalent


• 2+ years of medical billing and coding experience in a physician practice


• Working knowledge of CPT, ICD-10-CM, HCPCS, and modifier usage


• Experience with payer rules, EOBs/ERAs, and denial management


• Proficiency with practice management/EHR system and Microsoft Excel


• Strong attention to detail, organization, and communication skills

Preferred

• Active CPC, CCS-P, or equivalent certification (AAPC or AHIMA).


• Orthopedic or surgical specialty billing/coding experience.


• Experience with workers' compensation and auto/liability billing.


• Familiarity with global surgical packages, implant billing, and DME.


• Experience with [EHR/PM system, e.g., athenahealth].

Skills & Competencies

• Analytical thinker who can interpret clinical documentation and payer policies.


• Self-motivated, able to manage a high-volume workload and meet deadlines.


• Collaborative team player with strong provider and cross-department communication.


• Commitment to confidentiality, accuracy, and compliance.

Work Environment

• Remote/Hybrid position (onboarding will be onsite at the Lithia Springs Office), traveling to Lithia Springs as needed for training or leadership meetings.


• Extended periods of computer work.


• Standard hours Monday–Friday,


• High volume workloads with deadlines.