Billing Specialist

Description

Responsible for accurately entering daily charges for ambulatory surgical center. Duties include comprehensive chart reviews, verification of patient demographics, and assignment of appropriate modifiers, diagnosis codes, and revenue codes in accordance with current coding and reimbursement standards to ensure successful claim submission and reimbursement.

Key Responsibilities

• Retrieve preoperative documentation from the assigned transcription provider.
• Review and extract relevant data from medical records, operative and progress notes, invoices, and discharge summaries to ensure completeness and accuracy of charge entries.
• Accurately capture and report implants, high-cost supplies and drugs, post-operative pain blocks, and observation times before charge submission.
• Verify invoice accuracy, including customer billing details, pricing, discounts, and applicable state taxes.
• Manage and execute the recurring billing process, including daily generation and transmission of claims.
• Address and resolve internal and external billing inquiries (e.g., operative reports, invoices, or implant pricing discrepancies).
• Support month-end close activities by reconciling revenue and billing data.
• Ensure timely and accurate charge entry for all assigned cases and submit to the designated electronic claims clearinghouse daily.
• Resolve claim rejections promptly to facilitate clean claim transmission to appropriate payers.
• Stay up to date with healthcare billing regulations, payer policies, and industry developments.
  
  

Requirements

• Minimum of 2 years’ experience in ambulatory surgery center (ASC) revenue cycle, orthopedic billing, charge entry, or collections.
• Proficient in reading and interpreting insurance EOBs (Explanation of Benefits) and managed care agreements.
• Strong verbal and written communication skills
• Ability to manage multiple priorities and deadlines in a fast-paced environment.
• Familiarity with various healthcare payers is preferred.
• Intermediate proficiency in Microsoft Office applications, especially Excel and Outlook.
• Experience with billing software such as HST, Waystar, or RevSpring is a plus.
• High school diploma or equivalent required.
  
  

TOA is an equal opportunity employer. TOA conducts drug screens and background checks on applicants who accept employment offers.