Medical Billing Claims Specialist

Job Title

Summit Spine and Joint Centers (SSJC) is seeking a motivated, qualified professional for a remote position.

Job Duties

The ideal candidate will be responsible for:

• Auditing and ensuring claim information is complete and accurate.
• Submitting claims for office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management.
• Ensuring accurate and timely billing of HCFA 1500 claims.
• Documenting files with appropriate information.
• Creating logs for providers of pending medical encounters and or encounters with errors.
• Working directly with other billing staff and management to meet end of month closing deadlines.
• Handling clearinghouse rejections, printing, and mailing secondaries.
• Addressing inquiries from insurance companies, patients, and providers.
• Understanding CPT, ICD10, HCPCS coding and modifiers.
• Having knowledge of third-party payers, HMOs, PPOs, Medicare, Medicaid, Worker's Compensation, etc.
• Understanding ERAs, EOBs, and payer specific/LCD guidelines.
• Understanding health plan benefits (deductibles, copays, coinsurance) and eligibility verification.
• Being proficient with spreadsheets and word processing applications.

Qualifications

The candidate should have:

• 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.

Preferred Location

While this is a remote position, preference will be given to candidates residing in one of the following states:

• Georgia
• Texas
• North Carolina
• South Carolina
• Florida

Candidates located in Georgia should be able to attend meetings or training at our Lawrenceville administrative office as needed.

Compensation & Benefits

This is a full-time position offering a competitive salary, paid time off (PTO), comprehensive health benefits, and a 401(k) with company match.