Job Summary

 

The Billing Specialist, Payment Poster plays a critical part in maintaining the financial integrity of the practice by ensuring accurate and efficient billing and revenue collection for a wide range of orthopedic services. This role is responsible for follow-up and resolution to optimize reimbursement from insurance carriers and patients on a timely basis. The Billing Specialist must possess comprehensive experience in orthopedic or surgical billing, a solid grasp of healthcare insurance procedures, and the ability to troubleshoot complex billing issues with professionalism and attention to detail. The Billing Specialist will serve as a key liaison between our patients, providers, and insurance companies to help ensure timely reimbursement and optimal revenue performance. The Billing Specialist will be responsible for processing the full lifecycle of medical claims—from charge entry and claim submission to payment posting, denial management, and patient billing.

 

Duties and Responsibilities

 

• Demonstrate our core values of being patient centered, team focused, service driven, accountable, and innovative every day.


• Track claim status using payer portals and billing software; investigate and resolve rejections or denials promptly.


• Prepare and submit appeals for denied claims, including documentation and provider narratives as needed.


• Identify and report trends in denials, underpayments, and billing errors to support performance improvement.


• Generate and review routine reports, including aging summaries and outstanding claims status.


• Communicate with insurance companies to verify coverage, benefits, prior authorizations, and patient financial responsibility.


• Respond professionally to patient and insurance inquiries via phone or email; assist with resolving account questions or concerns.


• Assist with Accounts Receivable (A/R) follow-up and collection activities on past due accounts as directed by the Billing Manager.


• Maintain strict confidentiality of patient health and financial information in compliance with HIPAA and practice policies.


• Demonstrate working knowledge of health insurance plans, billing processes, and industry-standard coding practices (CPT, ICD-10, HCPCS).


• Post insurance and patient payments, adjustments, and credits to patient accounts in a timely and accurate manner. (may move to Billing Specialist, Payment Poster)


• Evolve in your role when performing supplemental responsibilities as assigned.