Medical Billing Claims Specialist

Join to apply for the Medical Billing Claims Specialist role at Mambo Seafood Restaurants Summit Spine and Joint Centers is a rapidly expanding Pain Management Group looking to add an experienced Medical Billing Specialist to our team. With twelve ambulatory surgery centers and twenty-three clinic locations across the State of Georgia, Summit Spine is winning the race to become the largest comprehensive spine and joint care provider in the state. We are looking for a motivated and hard‑working Claims Processor who can join our growing team of professionals. Job Duties Audit and ensure claim information is complete and accurate. Claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management. Ensure accurate and timely billing of HCFA 1500 claims. Ensure that files are documented with appropriate information (i.e., date stamped, logged, signed, etc.). Create logs for providers of pending medical encounters and encounters with errors. Work directly with other billing staff and management to meet end‑of‑month closing deadlines. Handle clearinghouse rejections, print, and mail secondaries. Address inquiries from insurance companies, patients, and providers. Understand CPT, ICD‑10, HCPCS coding and modifiers. Have knowledge of third‑party payers, HMOs, PPOs, Medicare, Medicaid, Worker's Compensation, etc. Be familiar with ERAs, EOBs and payer‑specific/LCD guidelines. Understand health plan benefits (deductibles, copays, coinsurance) and eligibility verification. Be proficient with spreadsheets and word processing applications. Qualifications Minimum of 3 years’ experience with medical billing or revenue cycle in a medical setting. Experience with Medicare, Medicaid, commercial insurance plans, Workers’ comp, and personal injury cases. Knowledge of claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management. Knowledge of medical billing rules such as coordination of benefits, modifiers, and understanding of EOBs and ANSI code denials. Excellent knowledge of CPT coding, ICD‑10 coding and medical pre‑certification protocols required. Excellent computer skills and familiarity with Microsoft Office. Comfortable working in a growing, dynamic organization and able to navigate change. Self‑motivated with ability to multi‑task, prioritize work in a fast‑paced, team environment. Bachelor’s degree preferred. Experience using eClinicalWorks preferred. Experience with pain management preferred. The position is full time with competitive salary, PTO, health benefits and 401(k) match. The ideal candidate will be located in Georgia and able to be present at our administrative office, or near Austin, Texas where other members of the billing team are located. #J-18808-Ljbffr Mambo Seafood Restaurants