Billing Specialist

Direct-Orthopedic-Care; Addison (TX); Sur place; USD 32 000 - 39 000; Plein temps

Résumé du poste

Direct-Orthopedic-Care (DOC) in Addison, TX is seeking an Orthopedic Billing Specialist to join our service-driven healthcare team. This full-time clerical role focuses on accurate coding, claim processing, and adherence to DOC standards to ensure timely payments.

The ideal candidate has at least two years of medical billing experience, orthopedic billing exposure, CPT/HCPCS and ICD-10-CM knowledge, and strong communication skills to collaborate with providers and staff.

Qualifications

• High school diploma or equivalent required.
• Minimum two years of medical billing experience, orthopedic experience preferred.
• Strong CPT/HCPCS, ICD-10-CM, modifiers knowledge.
• Ability to interpret payer requirements and use PM/EMR systems.

Responsabilités

• Review encounters within DOC turnaround standards.
• Ensure claims have correct coding, docs, provider info, and billing elements.
• Monitor unsubmitted encounters and billing holds to resolution.
• Submit electronic claims and fix clearinghouse rejections.
• Maintain audit trails of claim reviews and follow-ups.

Connaissances

Sound judgment

Accountability

Professional communication

Timely escalation

Teamwork

Flexibility

Guest service mindset

Formation

High school diploma or equivalent

Outils

Practice management software

EMR systems

Description du poste

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Clerical Addison, TX, US

Salary Range: $23.00 To $28.00 Hourly

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:

• sound judgment;
• accountability;
• 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.