Billing Specialist/Patient Accounts

The Billing Specialist is responsible for managing all aspects of medical billing claims resolution for the orthopedic practice, including informing RRCM coders and NFS CBO billers of discrepancies or errors regarding claim submission, payment posting, denial management, and patient account resolution. This position requires expertise in orthopedic and pain management billing procedures, insurance verification, coding compliance, and revenue cycle management to ensure accurate and timely reimbursement for services rendered. Responsibilities Review patient accounts and charges for accuracy, completeness, and compliance with coding guidelines Verify insurance eligibility and benefits prior to patient services and procedures Work weekly spreadsheets sent from coders, address/resolve issues preventing claims from being created or billed out Monitor claim status and follow up on outstanding claims to ensure timely payment Take patient payments, accurately enter them into the practice management system Reconcile daily payment batches Work as a Liaison to coders and billers, researching and resolving claim denials, rejections, and underpayments through appeals and corrective rebilling Work directly with the subject matter expert (SME) at the CBO to resolve billing discrepancies and payment issues Manage patient accounts and contact patients regarding insurance eligibility issues, demographic errors, and outstanding balances Compliance & Documentation Ensure compliance with HIPAA regulations, insurance billing requirements, and federal/state healthcare laws Maintain accurate and detailed documentation of all billing activities, communications, and patient account notes Create ER consult and surgery appointments for on-call cases, adding insurance, demographics, global periods and insurance alerts Stay current with CPT, ICD-10, and HCPCS coding updates relevant to orthopedic services Collaborate with clinical staff to ensure proper documentation supports billing and coding Revenue Cycle Support Generate and analyze aging reports to identify and prioritize collection activities Update PAR lists for each provider via the Medallion portal/NFS credentialing staff and share with staff for scheduling purposes to ensure that patients are scheduled with providers who are in network with their insurance Communicate with the orthopedic/pain-management surgeons, medical staff, and management regarding billing matters Provide excellent customer service to patients regarding billing questions and payment arrangements Additional Duties Cross-train in other business office functions to provide coverage as needed Attend staff meetings and participate in continuing education opportunities Perform other duties as assigned by the Business Office Manager Required Skills & Qualifications Technical Skills Proficiency in medical billing software and practice management systems (experience with orthopedic-specific systems preferred) Strong knowledge of insurance claim processes and revenue cycle Understanding of CPT, ICD-10, and HCPCS coding with emphasis on orthopedic and pain-management procedures Familiarity with Medicare, Medicaid, commercial insurance, workers' compensation, and personal injury billing Proficient in Microsoft Office Suite (Word, Excel, Outlook) Ability to navigate insurance carrier websites and electronic clearinghouses Professional Skills Excellent attention to detail and organizational skills Strong analytical and problem-solving abilities Effective written and verbal communication skills Ability to work independently and manage multiple priorities Professional demeanor when interacting with patients, insurance representatives, and team members Commitment to maintaining confidentiality and HIPAA compliance Clear communication is needed to coordinate with colleagues, management, and North Florida Surgeons (NFS) Education & Experience Required High school diploma or GED equivalent Minimum 3-5 years of medical billing experience, preferably in an orthopedic or surgical specialty practice Demonstrated knowledge of insurance billing procedures and revenue cycle management Experience with claim submission, denial management, and payment posting Preferred Associate's degree in healthcare administration, medical billing, or related field Certified Professional Biller (CPB) or Certified Medical Reimbursement Specialist (CMRS) certification Prior experience working in an orthopedic practice or surgical center Knowledge of workers' compensation and personal injury billing processes specific to orthopedics Experience with electronic health records (EHR) and practice management systems Working Conditions Full-time position with standard business office hours (Monday-Friday) Office environment with prolonged periods of sitting and computer use May require occasional overtime during peak billing periods or month-end closing Minimal travel required (occasional training or professional development opportunities) #J-18808-Ljbffr