Billing Specialist

Direct Orthopedic Care; Addison (TX); On-site; USD 40,000 - 70,000; Full time

Job summary

You will validate diagnoses, ensure documentation, manage billing queues, and resolve rejections. The role requires at least two years of medical billing, including orthopedic billing, with CPC certification preferred.

Qualifications

• High school diploma or equivalent is required.
• Minimum two years of medical billing experience, including orthopedic billing.
• Knowledge of CPT/HCPCS, ICD-10-CM, modifiers, and payer requirements.

Responsibilities

• Review clinical notes and supporting documents to ensure billed services are documented.
• Validate CPT/HCPCS codes, modifiers, and diagnosis pointers.
• Elevate documentation deficiencies before finalizing claims.
• Verify provider information and required authorizations per workflows.
• Prepare and process various insurance/billing types and submit electronic claims.
• Review billing queues and resolve rejections; maintain audit trails.
• Document reviews and follow-up actions for compliance and quality.

Skills

Medical billing

Orthopedic billing

Attention to detail

Professional communication

Time management

Teamwork

Independent workload management

Escalation

Education

High school diploma or equivalent

Active CPC certification

Tools

Practice management software

EMR systems

Job description

As members of the DOC team, we are instrumental in bringing hospitality to healthcare. Come join DOC as an Orthopedic Billing Specialist for our service driven organization.

As a Billing Specialist, your lead outcomes will include:

• Assigned encounters are reviewed and processed within established DOC turnaround standards.
• Ensuring claims contain accurate coding, supporting documentation, provider information, and required billing elements.
• Unsubmitted encounters and billing holds are actively monitored, documented, and followed through resolution.
• Productivity, billing accuracy, and preventable-error performance meet established department standards.
• Financial adjustments and payment allocations are accurate, supported, and completed within authorized limits.

As a Billing Specialist, your core responsibilities will include:

• Review clinical notes, operative reports, and supporting documents to confirm that billed services are documented.
• Validate CPT/HCPCS and ICD-10-CM codes, modifiers, diagnosis sequencing, and diagnosis pointers.
• Evaluate coding edits using approved resources and elevate questions or documentation deficiencies before finalizing claims.
• Verify insurance information, billing/rendering/referring/ordering providers, and required authorization or cosignature information according to applicable workflows.
• Prepare and process assigned insurance, workers' compensation, LOP, self-pay, surgery, DME, and special encounter billing.
• Submit electronic claims and resolve assigned clearinghouse rejections.
• Review assigned billing queues for unsubmitted, delayed, or missed encounters; maintain accurate billing statuses and follow-up records.
• Apply approved charges, discounts, and adjustments and allocate existing payments according to DOC policies and authorization limits.
• Document claim reviews, corrections, outstanding requirements, communications, and follow-up actions to maintain an adequate audit trail.
• Communicate professionally with providers and internal departments to resolve billing barriers and promptly notify leadership of delays or recurring issues.
• Follow established SOPs, protect confidential information, and participate in training, quality reviews, and process improvement.

As a Billing Specialist, DOC requires the following competencies:

• Attention to detail;
• sound judgment;
• independent workload management;
• accountability;
• active listening;
• professional communication;
• timely escalation;
• teamwork;
• flexibility; and
• behaviors that model DOC values and deliver an exceptional guest service experience.

Required Qualifications:

• High school diploma or equivalent.
• Minimum two years of medical billing experience, including at least one year in orthopedic billing.
• 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 applicable payer requirements and contractual billing provisions and use practice management and electronic medical record systems.

Required experience:

• Medical Billing: 2 years

Preferred license or certification:

• Active Certified Professional Coder (CPC) certification.

Job Type: Full-time