Billing Specialist

Orthopedic Billing Specialist

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 escalate 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:

• Attention to detail;
• sound judgment;
• independent workload management;
• accountability;
• active listening;
• 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.

Job Type: Full-time