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