Billing Procedure Claims Specialist

Company Overview:

Summit Spine and Joint Centers (SSJC) is a rapidly growing, multi-state Interventional Pain Management group practice providing integrated clinical, surgical, and imaging services. With clinic locations across Georgia, North Carolina, South Carolina, and Tennessee, our care teams include Integrated Pain Solutions in North Carolina and Savannah Pain Management in Georgia, all operating as part of the SSJC organization. As one of the largest single-specialty practices in the nation, we are committed to collaboration, high-quality patient-centered care, and supporting our teams as we continue to expand. We are seeking motivated, qualified professionals to join us in delivering exceptional care across our growing network.

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.
  
  
  

Qualifications:

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

The position is full time with competitive salary, PTO, health benefits and 401k match. The ideal candidate will be located in Georgia and able to be present at our administrative office, or near Austin, Texas where other members of the billing team are located.