Medical Billing Claims Specialist

Company Overview: Summit Spine and Joint Centers (SSJC) is a rapidly growing, multi-state Interventional Pain Management practice providing comprehensive clinical, surgical, and imaging services. With locations across Georgia, North Carolina, South Carolina, Tennessee, Florida, and Texas, our team is committed to delivering exceptional, patient-centered care through collaboration, innovation, and clinical excellence. As one of the largest single-specialty pain management practices in the nation, SSJC continues to expand its network while investing in the people who make our success possible. We are seeking motivated, qualified professionals who are passionate about making a meaningful impact and contributing to our continued growth. 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 Pain Management preferred. Preferred Location: While this is a remote position, preference will be given to candidates residing in one of the following states: Georgia Texas North Carolina South Carolina Florida Candidates located in Georgia should be able to attend meetings or training at our Lawrenceville administrative office as needed. Compensation & Benefits: This is a full-time position offering a competitive salary, paid time off (PTO), comprehensive health benefits, and a 401(k) with company match. The employee must communicate professionally, respectfully, and effectively with patients, visitors, clinicians, coworkers, and vendors, including in busy, demanding, or stressful circumstances. The employee must maintain professional composure and consistently perform assigned duties throughout the scheduled work period; manage routine workplace stressors and feedback without disrupting patient care, patient-facing operations, or coworkers’ work; and use established de-escalation and escalation procedures when appropriate. The employee must exercise sound judgment; maintain appropriate workplace boundaries; receive and respond to routine feedback and direction; protect confidential patient and business information; and address patient or workplace concerns through established supervisory and safety procedures. These functions are essential to the position.