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.

Qualifications

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.

Benefits

We offer a comprehensive benefits package that includes health (with employer contribution), dental, and vision insurance, employer paid base life, and other voluntary benefits*. Time off benefits include paid combined time off (CTO) and seven paid holidays, plus a floating holiday after one year of service. Retirement benefits include a 401(k) with company contribution and profit sharing after one year of service. Qualified team members become eligible to participate in medical benefits on the 1st of the month following date of hire, and retirement benefits after 90 days.

We also provide professional development opportunities, flexible work schedules, wellness incentives, healthy vending options, and relaxed dress code on Fridays. Our community-focused culture encourages participation in local events, fundraisers, and causes chosen by our team. We are committed to providing our employees with the resources they need to thrive both personally and professionally.

*Other voluntary benefits include Voluntary Short Term Disability, Long Term Disability, Critical Illness, Accident Insurance, Supplemental Life Insurance, and legal and identity protection and pet insurance.

Who We Are

Excelsior Orthopaedics is a multi-specialty orthopedic practice that has been providing comprehensive care since 2002. We have multiple locations throughout the Western New York region and a free-standing ambulatory surgery center, Buffalo Surgery Center. Excelsior Orthopaedics offers a suite of in-house services including general orthopaedic evaluation and treatment, podiatry, physical & occupational therapy, nutrition counseling, sports training, outreach athletic training, orthopaedic express care, imaging, durable medical equipment, and an outpatient total joint program. Buffalo Surgery Center provides surgical and procedural treatments for orthopaedic, pain and spine, podiatry, total joint replacement, and gastrointestinal patients. Our mission is to transform the lives of our patients by restoring function and enhancing quality of life. We are committed to innovative care that is driven by patient needs and supported by the most skilled, experienced team in Western New York.

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.

Excelsior Orthopaedics Group

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