Clinical Coding Billing & AR Specialist

The Clinical Coding Billing & AR Specialist is responsible for the accurate coding, billing, claims submission, payment posting, denial management, and collection of accounts receivable for clinical and surgical services. This position ensures compliance with federal, state, payer, and organizational guidelines while maximizing reimbursement and maintaining high levels of billing accuracy. The specialist works collaboratively with physicians, clinical staff, practice management, and insurance carriers to resolve billing issues and optimize revenue cycle performance.

Responsibilities and Duties: 

• Coding and Charge Entry: Review and accurately assign ICD-10-CM, CPT, HCPCS, and modifier codes for orthopedic office visits, surgical procedures, injections, fracture care, durable medical equipment (DME), and ancillary services.
• Billing and Claims Management: Prepare, review, and submit clean claims to commercial, government, and workers’ compensation payers.
• Accounts Receivable and Collections: Follow up on unpaid, denied, or underpaid claims. Work aging reports and maintain established AR benchmarks. Communicate with insurance carriers regarding claim status, appeals, and payment resolution. Assist patients with billing inquiries and payment arrangements when appropriate.
• Payment Reconciliation: Assist with month-end reporting and revenue cycle reconciliation. 
• Compliance and Quality Assurance: Maintain compliance with HIPAA, CMS regulations, payer guidelines, and coding standards. Participate in internal audits and compliance reviews. Monitor regulatory changes affecting orthopedic coding and billing practices. Recommend process improvements to increase efficiency and reimbursement. 

Required Skills and Experience Qualifications:

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS)
• Experience in medical coding, billing, and accounts receivable experience. 
• Experience in orthopedic specialty coding experience. 
• Strong knowledge of ICD-10-CM, CPT, HCPCS, NCCI edits, and payer guidelines. 
• Experience with orthopedic surgical coding, global periods, modifiers, fracture care, injections, and DME billing. 
• Proficiency with electronic health records (EHR) and practice management systems. 
• Experience with multi-provider orthopedic practices. 
• Excellent written and verbal communication skills. 

Education Requirements:

• Certified Professional Coder (CPC)Certified Coding Specialist (CCS)
• Associate's degree in Health Information Management, Medical Billing and Coding, or related field.