Billing & Coding Specialist Revenue Cycle Team

Position: Billing & Coding Specialist Revenue Cycle Team

Department: Revenue Cycle Management

Reports to: Revenue Cycle Director

Position Summary

The Billing & Coding Specialist is responsible for accurately assigning diagnosis and procedure codes for orthopedic services and managing the claim lifecycle from charge entry through payment posting and follow-up. This role works closely with providers, surgery schedulers, prior authorization staff, and front office teams to maximize clean claim rates, reduce denials, and support compliant, timely reimbursement.

Key Responsibilities

Coding

• Review clinic notes, operative reports, and procedure documentation to assign accurate ICD-10-CM, CPT, and HCPCS codes.
• Apply appropriate modifiers (e.g., -RT/-LT, -50, -51, -59, -62, -78, -79, -24, -25, -57) and global period rules.
• Code orthopedic services including E/M visits, fracture care, joint injections, DME dispensing, in-office procedures, imaging, and surgical cases.
• Ensure documentation supports medical necessity and coding level; query providers when documentation is incomplete or unclear.
• Stay current on CPT/ICD-10 updates, NCCI edits, and payer-specific coding policies.

Billing & Claims Management

• Enter charges and submit claims accurately and within timely filing limits.
• Review and resolve claim scrubber edits and rejections before submission.
• Verify insurance eligibility, authorizations, and referrals as needed for surgical and high-cost services.
• Bill for implants, bracing, DME, and ancillary services per payer requirements.
• Maintain audit documentation.

Denials, Follow-Up & Payment Posting

• Work denials and underpayments, prepare appeals, and track outcomes in a timely manner.
• Follow up on unpaid claims with commercial payers, Medicare, Medicaid, workers' compensation, and auto/liability carriers.
• Post payments, adjustments, and ERAs/EOBs, resolving any discrepancies.
• Identify denial trends and recommend process or documentation improvements.

Patient Accounts & Communication

• Respond to patient billing inquiries professionally and in a timely manner.
• Set up payment plans and assist with financial assistance processes per policy
• Coordinate with front desk and clinical staff to resolve registration, authorization, and documentation issues

Compliance & Quality

• Adhere to HIPAA, Medicare/CMS regulations, and internal compliance policies.
• Participate in coding audits and implement corrective actions.
• Meet established productivity, accuracy, and A/R targets.

Qualifications

Required

• High school diploma or equivalent
• 2+ years of medical billing and coding experience in a physician practice
• Working knowledge of CPT, ICD-10-CM, HCPCS, and modifier usage
• Experience with payer rules, EOBs/ERAs, and denial management
• Proficiency with practice management/EHR system and Microsoft Excel
• Strong attention to detail, organization, and communication skills

Preferred

• Active CPC, CCS-P, or equivalent certification (AAPC or AHIMA).
• Orthopedic or surgical specialty billing/coding experience.
• Experience with workers' compensation and auto/liability billing.
• Familiarity with global surgical packages, implant billing, and DME.
• Experience with [EHR/PM system, e.g., athenahealth].

Skills & Competencies

• Analytical thinker who can interpret clinical documentation and payer policies.
• Self-motivated, able to manage a high-volume workload and meet deadlines.
• Collaborative team player with strong provider and cross-department communication.
• Commitment to confidentiality, accuracy, and compliance.

Work Environment

• Remote/Hybrid position (onboarding will be onsite at the Lithia Springs Office), traveling to Lithia Springs as needed for training or leadership meetings.
• Extended periods of computer work.
• Standard hours Monday–Friday,
• High volume workloads with deadlines.

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