Medical Billing Executive

Role & responsibilities

- Strong knowledge of orthopedic and spine-related CPT, ICD-10, and HCPCS codes.
- Proficiency in medical billing software and electronic claim submission.
- Understanding of insurance verification, pre-authorizations, and reimbursement policies.
- Experience with medical record intake, review, and AI-driven reporting tools.
- Strong organizational and pipeline management skills.
- Excellent problem-solving skills for handling denials and appeals.
- Strong communication skills to interact with providers, insurance representatives, and patients.
- Detail-oriented and quality-focused with a commitment to accuracy.
- Ability to work independently and meet tight deadlines.
- Knowledge of HIPAA and medical billing compliance regulations.
- Flexibility to work overtime as needed to meet business demands.
- 2+ years of medical billing experience (preferably in an orthopedic, spine, or musculoskeletal practice).
- Experience with electronic health records (EHR) and medical billing software (e.g., Epic, NextGen, Athenahealth, Kareo, or Medisoft).

Preferred candidate profile

1. Medical Billing & Coding

• Assign correct CPT, ICD-10, and HCPCS codes for orthopedic and spine procedures.
• Ensure accurate charge entry and claim submission to insurance companies.
• Review medical records and provider documentation for proper coding compliance.

2. Insurance Verification & Authorization

• Verify insurance eligibility, benefits, and coverage for orthopedic/spine services.
• Obtain pre-authorizations for surgeries, imaging (MRI, CT scans), spinal injections, and physical therapy.
• Coordinate with insurance providers to ensure proper claim processing.

3. Claims Management & Denial Resolution

• Submit and track insurance claims to ensure timely reimbursement.
• Handle claim rejections, denials, and appeals, ensuring maximum reimbursement.
• Work with insurance companies, providers, and patients to resolve outstanding billing issues.

4. Medical Record Intake & Review

• Intake, review, and organize batches of medical records.
• Prepare medical summaries and chronologies for billing and documentation purposes.
• Utilize AI-driven tools to streamline and process various report types efficiently.

5. Report Monitoring & Pipeline Management

• Monitor and update the status of working reports in real-time to maintain workflow efficiency.
• Ensure a continuous case pipeline while meeting service-level agreements (SLAs).