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Spine Medical Biller MDCS, Management Services Organization Brea, CA Job Details Full-time $18 - $19 an hour 3 hours ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance Qualifications Customer communication Teamwork Microsoft Excel Operations management Attention to detail Time management Full Job Description Job Overview The Team Lead, Spine Medical Billing & Collections is responsible for overseeing the day-to-day revenue cycle operations for assigned spine and orthopedic spine accounts while providing leadership, guidance, and support to Billing Specialists. This position ensures the accurate and timely submission of professional claims for spine services, including office visits, injections, diagnostic procedures, and surgical services. The Team Lead is responsible for monitoring charge capture, coding and modifier accuracy, authorizations, claim submission, payment posting, denial management, appeals, accounts receivable follow-up, and client satisfaction. The position requires a strong understanding of spine-specific billing requirements, including surgical procedures, global surgical periods, assistant-at-surgery billing, payer-specific reimbursement policies, medical necessity requirements, and high-dollar surgical claims. The Team Lead serves as a primary escalation point for complex billing and reimbursement issues, monitors account performance, identifies opportunities to improve revenue and reduce denials, and ensures compliance with applicable coding, billing, payer, and regulatory requirements. Revenue Cycle Management Oversee the complete revenue cycle for assigned spine and orthopedic spine accounts, from charge entry through final payment resolution. Review charges and billing information for office visits, injections, diagnostic procedures, spine surgeries, and related services to ensure claims are complete and accurately submitted. Review and validate CPT, HCPCS, ICD-10-CM, and applicable modifier requirements for spine services. Ensure appropriate use and billing of surgical modifiers, including, when applicable, modifiers 24, 25, 57, 58, 78, 79, 80, 81, 82, and AS. Monitor global surgical periods and identify services that may require appropriate modifier usage or additional documentation. Review assistant-at-surgery claims to ensure the appropriate provider, modifier, procedure, and payer requirements are met. Monitor claim submission, payment posting, denial management, appeals, and collection activities to maximize reimbursement. Verify that required authorizations, referrals, medical records, operative reports, and other supporting documentation are available when required by the payer. Monitor high-dollar surgical claims and prioritize follow-up based on financial impact, payer requirements, and aging. Ensure timely filing requirements and payer-specific billing guidelines are met. Monitor accounts receivable and prioritize follow-up on high-dollar, aged, denied, underpaid, and unpaid claims. Review and resolve claim edits, rejections, clearinghouse issues, and EDI errors. Analyze payer denials and underpayments to identify trends and determine appropriate corrective action, including appeals and claim corrections. Research payer reimbursement policies, contractual requirements, medical policies, and billing guidelines related to spine procedures. Collaborate with providers, surgical staff, coders, office personnel, and clients to obtain missing documentation and resolve billing discrepancies. Review operative reports and other supporting documentation when necessary to identify billing discrepancies or determine whether additional information is needed for claim submission or appeal. Identify potential missed charges, incorrect charges, duplicate billing, bundling issues, and other revenue-impacting errors. Spine-Specific Billing Responsibilities Maintain working knowledge of common spine procedures and related billing requirements, including cervical, thoracic, and lumbar procedures. Understand billing considerations for procedures such as spinal injections, epidural procedures, nerve blocks, radiofrequency procedures, discectomy, laminectomy, decompression, fusion, instrumentation, and other spine-related surgical services. Understand professional billing requirements associated with facility-based spine procedures and outpatient and inpatient surgical services. Monitor surgical claims for correct global-period handling, multiple-procedure billing, staged procedures, repeat procedures, postoperative complications, and unrelated services. Review claims involving co-surgeons, assistant surgeons, and surgical assistants for appropriate billing and documentation. Monitor payer-specific requirements for spine surgery, including authorization, medical necessity, documentation, and site-of-service requirements. Identify claims requiring operative reports, imaging reports, medical records, authorization documentation, or other supporting records. Assist with appeals involving medical necessity, authorization, bundling, global surgery, assistant-at-surgery, duplicate payment, and incorrect reimbursement issues. Monitor implant and supply-related billing when applicable and coordinate with the appropriate staff to ensure required information is available for billing. Stay current on payer policies and reimbursement changes affecting spine procedures and communicate significant changes to management and billing staff.

TEAM LEADERSHIP & SUPERVISION

Provide daily oversight, training, and support to Billing Specialist(s). Monitor staff productivity, quality, accuracy, and performance metrics. Conduct regular audits of claims, payments, denials, and accounts receivable to ensure billing accuracy and compliance. Assist with onboarding and ongoing training of billing staff, with emphasis on spine-specific billing practices. Serve as a primary resource for billing, coding, modifier, payer, denial, and reimbursement questions. Review complex claims and provide guidance to staff on appropriate follow-up and resolution. Escalate operational concerns, significant payer issues, and high-dollar account concerns to management. Identify training opportunities and recommend process improvements based on recurring billing errors or denial trends. Foster a collaborative, accountable, and customer-focused team environment.

CLIENT ACCOUNT MANAGEMENT

Serve as the primary billing contact for assigned clients. Maintain positive client relationships through proactive communication, timely follow-up, and effective issue resolution. Provide clients with detailed account analysis, billing updates, AR status, denial trends, and revenue cycle recommendations. Address client inquiries regarding demographics, charges, coding, billing, authorizations, claims, collections, and reimbursement issues. Communicate significant payer changes or recurring denial trends that may affect the client's revenue. Provide recommendations regarding claim workflow, documentation requirements, authorization processes, and denial prevention. Present monthly account performance summaries and key findings to management and/or clients, as applicable. Escalate significant account concerns, delayed payments, payer issues, and potential revenue loss proactively.

ADDITIONAL RESPONSIBILITIES

Research and resolve patient account disputes. Assist patients and client staff with billing-related inquiries in a professional manner. Process insurance claims and payment posting for other accounts as needed. Assist with month-end closing and reconciliation activities. Assist with payer audits, documentation requests, and other revenue cycle projects. Maintain current knowledge of payer policies, billing regulations, coding updates, and spine-specific reimbursement requirements. Assist management with special projects, workflow development, and process improvement initiatives. Perform other duties as assigned to support departmental objectives.

KNOWLEDGE & TECHNICAL SKILLS

Advanced knowledge of medical billing, collections, and revenue cycle management. Strong understanding of ICD-10-CM, CPT, HCPCS, modifiers, and specialty-specific billing requirements. Strong knowledge of spine and orthopedic surgical billing. Working knowledge of cervical, thoracic, and lumbar spine procedures and their related billing considerations. Strong understanding of global surgical periods and applicable surgical modifiers. Knowledge of assistant-at-surgery, co-surgeon, and multiple-procedure billing requirements. Knowledge of payer authorization, medical necessity, documentation, and reimbursement requirements. Knowledge of National Correct Coding Initiative (NCCI) edits and payer-specific bundling and reimbursement guidelines. Experience with denial management, claim corrections, reconsiderations, and appeals. Ability to research payer policies and interpret reimbursement requirements. Proficiency with Practice Management Systems (PMS), Electronic Health Records (EHR), clearinghouses, and payer portals. Advanced proficiency with Microsoft Office, including Excel and reporting tools. Knowledge of commercial insurance, Medicare, Medicare Advantage, Medicaid/Medi-Cal, workers' compensation, and other applicable payer types. Understanding of insurance reimbursement methodologies and contractual requirements. Understanding of HIPAA regulations and patient confidentiality requirements.

CHARACTERISTICS & COMPETENCIES

Strong leadership and coaching abilities. Strong knowledge of spine medical billing and surgical revenue cycle processes. Excellent analytical and problem-solving skills. Strong understanding of claim review, denial analysis, and AR follow-up. Strong organizational and time-management skills. Ability to prioritize high-dollar and time-sensitive claims. Ability to identify billing errors and revenue opportunities. Ability to research and resolve complex payer issues independently. Ability to interpret payer policies and apply them appropriately to billing situations. Ability to manage multiple client accounts and competing priorities in a fast-paced environment. Professional written and verbal communication skills. Detail-oriented with a strong commitment to billing accuracy and compliance. Self-motivated with the ability to work independently and collaboratively. Strong client-service skills and professional judgment. Bilingual preferred but not required.

Pay:

$18.00 - $19.00 per hour Expected hours: 40.0 per week

Benefits:

401(k) Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person