Billing Specialist

Direct Orthopedic Care•Addison, TX

5d•$23 - $28•Onsite

About The Position

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.

Requirements

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.
Attention to detail
sound judgment
independent workload management
accountability
active listening
professional communication
timely escalation
teamwork
flexibility
behaviors that model DOC values and deliver an exceptional guest service experience.

Nice To Haves

Active Certified Professional Coder (CPC) certification.

Responsibilities

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.