Billing Specialist

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.

As a Billing Specialist, your lead outcomes will include:

• Assigned encounters are reviewed and processed within established DOC turnaround standards.
• Ensuring claims contain accurate coding, supporting documentation, provider information, and required billing elements.
• Unsubmitted encounters and billing holds are actively monitored, documented, and followed through resolution.
• Productivity, billing accuracy, and preventable-error performance meet established department standards.
• Financial adjustments and payment allocations are accurate, supported, and completed within authorized limits.

As a Billing Specialist, your core responsibilities will include:

• 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.

As a Billing Specialist, DOC requires the following competencies:

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

Required Qualifications:

• 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.

Required experience:

• Medical Billing: 2 years

Preferred license or certification:

• Active Certified Professional Coder (CPC) certification.

Job Type: Full-time