Billing Specialist/Patient Accounts

North Florida Surgeons, P.A.•Fort Walton Beach, FL

2d•Onsite

About The Position

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.

Requirements

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
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)
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

Nice To Haves

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

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 send 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 your daily payment batches
Work as a Liaison to our coders and billers, to research and resolve claim denials, rejections, and underpayments through appeals and corrective rebilling
Work directly with our 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
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
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
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