Medical Billing Specialist

Job Summary

The Medical Billing Specialist will be responsible for managing the billing and coding processes to ensure accurate and timely submission of claims, maximizing reimbursement, and maintaining compliance with healthcare regulations. This role requires strong attention to detail, knowledge of medical billing practices, and the ability to work collaboratively with our clinical and administrative teams.

Duties/Responsibilities:

• Prepare, review, and submit accurate claims to insurance companies, Medicare, and Medicaid in a timely manner.
• Assign appropriate ICD10, CPT, and HCPCS codes to patient encounters, ensuring compliance with coding guidelines.
• Follow up on unpaid claims, denials, and appeals, resolving issues to secure maximum reimbursement.
• Maintain uptodate knowledge of payer policies, coding updates, and regulatory requirements.
• Answer and respond to patient phone calls and electronic messages regarding billing questions, statements, balances, and payment options in a professional and timely manner.
• Collaborate with clinical staff to ensure accurate documentation supports billing and coding requirements.
• Maintain patient confidentiality and adhere to HIPAA regulations.
  
  

Required Skills/Abilities:

• Experience with orthopedic practice management systems preferred.
• Proficiency in Microsoft Office Suite (Excel, Word) for reporting and data analysis.
• Ability to adapt to changing regulations and payer policies in the healthcare industry.
  
  

Education and Experience:

• High school diploma or equivalent required; associate’s or bachelor’s degree in healthcare administration, medical billing, or related field preferred.
• Certification in medical billing and coding (e.g., CPC, CBCS) is a plus but not required.
• Minimum of 2 years of experience in medical billing, preferably in an orthopedic or specialty practice.
• Proficiency in medical coding (ICD10, CPT, HCPCS) and understanding of payer requirements.
• Experience with electronic medical record (EMR) systems; experience with ModMed (Modernizing Medicine) is a strong plus.
• Prior experience in an orthopedic practice is highly desirable.
• Strong knowledge of insurance processes, including Medicare, Medicaid, and commercial payers.
• Excellent attention to detail, organizational skills, and ability to manage multiple tasks.
• Effective communication skills to interact with patients, staff, and insurance representatives.
• Familiarity with denial management, appeals processes, and revenue cycle management.
  
  

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
  
  

Benefits:

• Health, dental, vision, disability, company paid life insurance, 401(K) with company match, PTO, paid holidays, employee perks
  
  

This is a full-time, non-exempt position working Monday-Friday.

OrthoLA is an equal opportunity employer.