Billing & Coding Specialist Revenue Cycle Team

ReVive Orthopedics Spine & Sports Medicine; United States; Hybrid; USD 52,000 - 66,000; Full time

Job summary

ReVive Orthopedics Spine & Sports Medicine seeks a Billing & Coding Specialist to manage ICD-10-CM, CPT, and HCPCS coding for orthopedic services and oversee the entire claim lifecycle from charge entry to payment posting.

Collaborate with providers, schedulers, and front office to maximize clean claims, reduce denials, and ensure compliant, timely reimbursement. Remote/hybrid with onsite Lithia Springs onboarding.

Qualifications

• 2+ years of medical billing and coding in a physician practice.
• High school diploma or equivalent.
• 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.

Responsibilities

• Review clinic notes, operative reports, and documentation to assign ICD-10-CM/CPT/HCPCS codes.
• Apply modifiers and global period rules.
• Code orthopedic services including E/M visits, fractures, injections, DME, imaging, and surgical cases.
• Verify documentation supports medical necessity and query providers when needed.
• Enter charges and submit claims within timely filing limits.
• Post payments, follow up on denials, and manage appeals.

Skills

Medical billing & coding

CPT/ICD-10-CM/HCPCS knowledge

Denial management

EHR/PM systems

Microsoft Excel

Education

High school diploma or equivalent

Tools

Athenahealth

Practice management software

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.