Medical Coder & Billing Specialist

Protouch Staffing; Houston (TX); Híbrido; USD 37.000 - 41.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

401(k)

401(k) matching

Dental insurance

Flexible schedule

Health insurance

Paid time off

Parental leave

Retirement plan

Vision insurance

Descripción de la vacante

Protouch Staffing in Houston, TX is seeking an Experienced Medical Coder & Billing Specialist to manage workers' compensation billing for orthopedic surgery, ASC, anesthesia, X-ray, clinic, and urgent care services.

The role requires independent work, ability to identify coding and billing errors, resolve denials, and ensure compliant submission of claims through the revenue cycle. Hands-on WC billing experience and CPT/ICD-10-CM knowledge are essential.

Formación

• Hands-on workers' compensation billing experience is mandatory.
• Experience with workers' compensation claims involving orthopedic injuries, surgery, imaging, or outpatient services.
• Strong ASC facility coding and billing experience.
• Experience coding and billing orthopedic procedures.
• Working knowledge of anesthesia, radiology, clinic and urgent care billing.
• Proficiency in CPT, ICD-10-CM, HCPCS, modifiers, and applicable coding guidelines.
• Knowledge of workers' compensation fee schedules, authorization requirements, and state rules.
• Experience with commercial insurance and Medicare billing as applicable.

Responsabilidades

• Process and submit workers' compensation claims for work-related injuries and procedures.
• Verify claim information, employer and insurer details, authorization requirements, and adjuster information.
• Follow up with carriers and payers regarding claim status and reimbursements.
• Resolve denials, underpayments, and disputed claims.
• Code and bill ASC facility claims for orthopedic procedures and anesthesia.
• Review operative reports for CPT/ICD-10-CM and modifiers.
• Review billing for implants, supplies, and other services per payer rules.
• Denial management and revenue cycle tasks including appeals and corrected claims.
• Review anesthesia records and verify time, units, and modifiers.
• Code imaging services and understand 26/TC components.
• Handle clinic and urgent care billing, including E/M and minor procedures.

Conocimientos

Workers' compensation billing

Orthopedic billing

ASC billing

Anesthesia billing

Radiology billing

Claims denial resolution

Educación

CPC, CCS certification

Herramientas

Practice management systems

Clearinghouses

Electronic Health Records (EHR)

Descripción del empleo

Experienced Medical Coder & Billing Specialist

We are seeking a highly experienced, detail-oriented Medical Coder and Billing Specialist with strong hands-on experience in workers' compensation billing, ambulatory surgery center (ASC) billing, orthopedic surgery, anesthesia, radiology/X-ray, clinic billing, and urgent care. The ideal candidate must have proven experience handling workers' compensation claims and understand the specific billing, documentation, authorization, coding, and reimbursement requirements associated with occupational injuries and work-related surgical procedures. We are looking for someone who can work independently, identify coding and billing errors, resolve complex denials, follow claims through reimbursement, and maintain compliance with applicable coding guidelines and payer requirements.

Key Responsibilities

• Process and submit workers' compensation claims for work-related injuries, orthopedic procedures, diagnostic imaging, clinic visits, urgent care services, and surgical procedures.
• Verify claim information, employer and insurance details, claim numbers, dates of injury, authorization requirements, and adjuster information as applicable.
• Understand workers' compensation billing requirements, including state-specific rules, fee schedules, documentation, and timely filing deadlines.
• Follow up with workers' compensation carriers, adjusters, employers, and other relevant parties regarding claim status, reimbursement, and outstanding balances.
• Resolve denials, underpayments, authorization issues, and disputed claims.
• Understand the billing process for work-related orthopedic surgeries, ASC services, anesthesia, and X-rays.
• ASC and Orthopedic Surgery Billing
• Code and bill ASC facility claims for orthopedic procedures.
• Review operative reports and verify appropriate CPT, ICD-10-CM, HCPCS, and modifier usage.
• Understand the distinction between ASC facility billing and professional billing.
• Review billing for implants, supplies, and other separately reportable services according to applicable payer requirements.
• Resolve surgical claim denials, coding edits, and reimbursement discrepancies.
• Anesthesia Billing
• Review anesthesia records, documented time, applicable units, provider arrangements, and required modifiers.
• Identify and resolve anesthesia billing errors and denials.
• Understand payer-specific anesthesia reimbursement requirements.
• X-Ray and Radiology Billing
• Code and bill diagnostic imaging services.
• Understand technical and professional components and the appropriate use of modifiers 26 and TC when applicable.
• Verify medical necessity, documentation, and coding accuracy.
• Clinic and Urgent Care Billing
• Handle office visits, urgent care encounters, E/M services, minor procedures, injections, X-rays, and other outpatient services.
• Understand appropriate coding, documentation, bundling edits, and modifier requirements.
• Ensure accurate diagnosis coding and appropriate claim submission.
• Denial Management and Revenue Cycle
• Submit clean claims and investigate rejected or denied claims.
• Work accounts receivable, appeals, corrected claims, and payment discrepancies.
• Review EOBs and ERAs, identify underpayments, and follow up on outstanding balances.
• Maintain accurate records and communicate effectively with providers, billing staff, insurance companies, and workers' compensation adjusters.

Required Qualifications

• Demonstrated hands-on workers' compensation billing experience is mandatory.
• Experience with workers' compensation claims involving orthopedic injuries, surgery, imaging, or other relevant outpatient services.
• Strong ASC facility coding and billing experience.
• Experience coding and billing orthopedic surgical procedures.
• Working knowledge of anesthesia, radiology/X-ray, clinic, and urgent care billing.
• Proficiency in CPT, ICD-10-CM, HCPCS, modifiers, and applicable coding guidelines.
• Knowledge of workers' compensation fee schedules, authorization requirements, claim documentation, and state-specific billing rules.
• Experience with commercial insurance and Medicare billing, as applicable to the role.
• Proven ability to investigate denials, resolve billing issues, and follow claims through final resolution.
• Strong attention to detail, organizational skills, and independent problem-solving abilities.

Preferred Qualifications

• CPC, CCS, or another relevant coding certification.
• Experience with multiple billing entities, specialties, or practice locations.
• Knowledge of NCCI edits, payer policies, reimbursement methodologies, and coding compliance.
• Experience with electronic health records, practice management systems, billing software, and clearinghouses.

Pay: $27.00 - $30.00 per hour

Expected hours: 30.0 - 45.0 per week

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Parental leave
• Retirement plan
• Vision insurance

Work Location: Hybrid remote in Houston, TX 77027

Important: Candidates without hands-on workers' compensation billing experience will not meet the minimum qualifications for this position.