Billing Specialist

The Billing Specialist is responsible for the accurate, timely, and compliant billing of professional and facility services for assigned orthopedic physicians, ambulatory surgery centers (ASCs), ancillary service lines, and related entities. Reporting to the Director of Coding & Billing, this position plays a critical role in ensuring complete revenue capture, clean claim submission, and reimbursement optimization while maintaining compliance with payer, regulatory, and organizational requirements.

The Billing Specialist partners closely with Coding, Clinical Operations, Finance, Practice Operations, and Revenue Cycle leadership to ensure billing accuracy, reduce denials, improve cash flow, and support enterprise revenue cycle performance across Growth Orthopedics.

Essential Duties:

Charge Review & Revenue Capture 

• Review operative reports, clinical documentation, physician notes, implant logs, invoices, anesthesia records, therapy documentation, and ancillary records to ensure complete and accurate charge capture.
• Verify patient demographics, insurance coverage, authorizations, referrals, and billing information prior to claim submission.
• Ensure accurate assignment of CPT, HCPCS, ICD-10-CM, modifiers, revenue codes, units, and other billing elements in accordance with payer and regulatory guidelines.
• Capture all billable services including professional physician services, ASC facility charges, surgical implants, high-cost supplies, biologics and injectable medications, durable medical equipment (DME), observation services, peripheral nerve blocks, and ancillary procedures.
• Review implant invoices and vendor documentation to ensure proper billing, reimbursement methodology, and charge accuracy.
• Validate documentation supports all billed services prior to claim submission.

Billing Operations

• Complete timely charge entry for assigned providers, surgery centers, clinics, and ancillary departments.
• Generate and submit clean electronic claims through designated clearinghouses within established turnaround standards.
• Review and resolve claim edits, front-end rejections, and clearinghouse exceptions daily.
• Ensure claims are billed in accordance with payer-specific billing guidelines and contractual requirements.
• Perform recurring billing functions and monitor billing work queues to ensure timely completion.
• Assist in correcting billing errors, claim corrections, rebilling, and late charge processes when necessary.
• Maintain established productivity and quality standards.

Revenue Integrity 

• Identify opportunities to improve revenue capture and reduce missed charges.
• Review documentation for billing compliance and identify missing or incomplete information prior to billing.
• Monitor billing trends and communicate recurring documentation or workflow issues to leadership.
• Assist with reconciliation of daily billing activity and month-end revenue close processes.
• Support implementation of new services, providers, procedures, and payer requirements.
• Participate in internal audits, compliance initiatives, and revenue integrity reviews.

Collaboration & Customer Service 

• Collaborate with physicians, clinical staff, coding, collections, finance, practice operations, and leadership to resolve billing issues.
• Respond promptly to internal and external inquiries regarding billing, documentation, reimbursement, and charge capture.
• Provide exceptional customer service while maintaining professionalism and confidentiality.
• Assist with education regarding documentation and billing requirements when appropriate.

Compliance 

• Maintain current knowledge of Medicare, Medicaid, commercial payer, Workers' Compensation, CPT, HCPCS, ICD-10-CM, NCCI edits, CMS reimbursement guidelines, and ASC/physician billing regulations.
• Maintain compliance with HIPAA, corporate compliance policies, and applicable federal and state regulations.

Qualifications

• High School Diploma or equivalent.

• Minimum two (2) years of healthcare billing, charge entry, or revenue cycle experience.

• Experience in orthopedic practices, ambulatory surgery centers, multi-specialty surgical practices, or physician practices preferred.

• Working knowledge of physician and facility billing methodologies.

• Knowledge of CPT, HCPCS, ICD-10-CM, modifiers, revenue codes, and payer billing requirements.

• Experience interpreting EOBs, remittance advice, and managed care contracts.

• Strong analytical, organizational, communication, and problem-solving skills.

• Intermediate proficiency with Microsoft Office applications.

Preferred Qualifications

• Certified Professional Biller (CPB) or equivalent certification.

• Orthopedic revenue cycle experience.

• ASC billing experience.

• Experience with implant billing and high-cost supply reimbursement.

• Experience with Workers' Compensation billing.

• Knowledge of bundled payment methodologies and value-based reimbursement.

• Experience supporting multiple practice locations and surgery centers.

Core Competencies

• Revenue Cycle Knowledge

• Billing Accuracy

• Revenue Integrity

• Critical Thinking

• Analytical Skills

• Problem Solving

• Organization & Time Management

• Collaboration

• Accountability

• Customer Service

• Adaptability

• Attention to Detail