Billing Procedure Claims Specialist

Summit Spine and Joint Centers•Lawrenceville, GA

2d•Onsite

About The Position

Summit Spine and Joint Centers is a rapidly expanding Pain Management Group looking to add an experienced Medical Billing Specialist to our team. With twelve ambulatory surgery centers and twenty-three clinic locations across the State of Georgia, Summit Spine is winning the race to become the largest comprehensive spine and joint care provider in the state. We are looking for a motivated and hard-working Claims Processor who can join our growing team of professionals. Job Duties: Audits and ensure claim information is complete and accurate. claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management. Ensures accurate and timely billing of HCFA 1500 claims. Ensures that files are documented with appropriate information (i.e., date stamped, logged, signed, etc.). Creates logs for providers of pending medical encounters and or encounters with errors. Work directly with other billing staff and management to meet end of month closing deadlines. Able to work with clearinghouse rejections, print, and mail secondaries. Address inquiries from insurance companies, patients, and providers. Understands CPT, ICD10, HCPCS coding and modifiers. Knowledge of third-party payers, HMOs, PPOs, Medicare, Medicaid, Worker's Compensation, etc. Knowledge of ERAs, EOBs Knowledge of payer specific/LCD guidelines Understanding of health plan benefits (deductibles, copays, coinsurance) and eligibility verification Must be proficient with spreadsheets and word processing applications.

Requirements

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.

Nice To Haves

Bachelor’s degree preferred.
Experience using eClinicalWorks preferred.
Experience with high level procedure billing and coding for Pain Management preferred

Responsibilities

Audits and ensure claim information is complete and accurate.
Claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management.
Ensures accurate and timely billing of HCFA 1500 claims.
Ensures that files are documented with appropriate information (i.e., date stamped, logged, signed, etc.).
Creates logs for providers of pending medical encounters and or encounters with errors.
Work directly with other billing staff and management to meet end of month closing deadlines.
Able to work with clearinghouse rejections, print, and mail secondaries.
Address inquiries from insurance companies, patients, and providers.
Understands CPT, ICD10, HCPCS coding and modifiers.
Knowledge of third-party payers, HMOs, PPOs, Medicare, Medicaid, Worker's Compensation, etc.
Knowledge of ERAs, EOBs
Knowledge of payer specific/LCD guidelines
Understanding of health plan benefits (deductibles, copays, coinsurance) and eligibility verification
Must be proficient with spreadsheets and word processing applications.