Billing & Coding Specialist Revenue Cycle Team

Revive Orthopedics•,

3d•Hybrid

About The Position

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. The 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. The specialist reviews clinical documentation, assigns appropriate codes and modifiers, submits and follows up on claims, resolves denials and payment discrepancies, and responds to patient billing inquiries. The role also supports compliance and quality through audits, accurate documentation, and adherence to productivity, accuracy, and accounts receivable targets. This is a remote/hybrid position. Onboarding is onsite at the Lithia Springs Office, with travel to Lithia Springs as needed for training or leadership meetings. The work involves extended periods at a computer and high-volume workloads with deadlines. Standard hours are Monday through Friday.

Requirements

High school diploma or equivalent.
At least 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 a practice management/EHR system and Microsoft Excel.
Strong attention to detail, organization, and communication skills.

Nice To Haves

Active CPC, CCS-P, or equivalent AAPC or AHIMA certification.
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 an EHR/PM system such as athenahealth.

Responsibilities

Review clinic notes, operative reports, and procedure documentation to assign accurate ICD-10-CM, CPT, and HCPCS codes.
Apply appropriate modifiers 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.
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 according to payer requirements.
Maintain audit documentation.
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 discrepancies.
Identify denial trends and recommend process or documentation improvements.
Respond to patient billing inquiries professionally and in a timely manner.
Set up payment plans and assist with financial assistance processes according to policy.
Coordinate with front desk and clinical staff to resolve registration, authorization, and documentation issues.
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.