Billing Specialist

Job Summary

The Billing Specialist 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.

Requirements and Qualifications

• High school diploma or equivalent required; associate degree or certification in medical billing/coding (e.g., CMB, CMRS) strongly preferred.
• Minimum 2 years of billing experience in a healthcare setting, preferably in orthopedics or surgical specialties required.
• Proficiency in CPT, ICD-10, and HCPCS coding specific to musculoskeletal and surgical services preferred.
• Demonstrated knowledge with EMR systems (e.g. Medent, Epic, or similar) is required.
• Comprehensive knowledge of commercial, Medicare, Medicaid, and workers’ comp billing procedures preferred.
• Strong analytical skills to interpret EOBs, address denials, and resolve account discrepancies preferred.
• Demonstrated attention to detail, time management, and organizational abilities.
• Effective interpersonal and communication skills for interactions with patients and team members.
• Ability to work independently, meet deadlines, and adapt in a fast-paced environment.
• Computer skills required with minimum proficiency in Microsoft Word, Excel, Outlook, and Teams.

Physical Demands

• Manual and finger dexterity and eye-hand coordination to enter data and operate office equipment
• Corrected vision and hearing within normal range to observe and communicate with patients, providers, and staff.
• Frequently remaining in a stationary position, often sitting for prolonged periods working on a computer, telephone, copy/fax machine, and other office equipment
• Occasional standing and walking required
• Occasional lifting and carrying items weighing up to 10 pounds.

The pay range for this position is determined based on several factors, including the candidate’s years of experience, qualifications, training, licenses, designations, and the overall market conditions.

This job description does not state or imply that the duties and responsibilities listed are the only ones required of this position.  Team members in this role will be required to perform other job-related duties at the discretion of the employer and may have additional duties assigned as necessary.  

Excelsior Orthopaedics and Buffalo Surgery Center are committed to the full inclusion of all applicants.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information.