Billing & Coding Specialist Revenue Cycle Team
Remote
Full Time
Mid Level
Position: Billing & Coding Specialist Revenue Cycle Team
Department: Revenue Cycle ManagementReports 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.
- 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.
- 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.
- 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
- 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
- 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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