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About the Company
The Billing Specialist – Wound Care is responsible for managing and processing claims related to wound care services, ensuring accurate coding, timely submission, and efficient reimbursement from payers. This role requires in-depth knowledge of medical billing practices, wound care terminology, and payer policies, including Medicare and commercial insurance requirements.
About the Role
The Billing Specialist – Wound Care is responsible for managing and processing claims related to wound care services, ensuring accurate coding, timely submission, and efficient reimbursement from payers. This role requires in-depth knowledge of medical billing practices, wound care terminology, and payer policies, including Medicare and commercial insurance requirements.
Responsibilities
- Accurately review and process wound care documentation to generate clean claims
- Submit claims electronically or manually to insurance carriers in a timely manner
- Ensure appropriate coding using ICD-10, CPT, and HCPCS specific to wound care procedures
- Work closely with providers and clinical staff to clarify documentation or resolve coding discrepancies
- Follow up on unpaid or denied claims; perform resubmissions and appeals as necessary
- Monitor aging reports and maintain established KPIs for claim turnaround time and resolution
- Verify patient insurance benefits and authorizations for wound care services when required
- Ensure compliance with HIPAA, payer-specific regulations, and internal billing policies
- Collaborate with clinical and operations teams to address billing-related issues proactively
- Assist with month-end reporting, audits, and reconciliation as needed
Qualifications
- High school diploma or equivalent (Associate’s or Bachelor's degree preferred)
- Minimum 2 years of medical billing experience, preferably in wound care or specialty care settings
- Strong knowledge of insurance claims processes, coding (CPT, ICD-10, HCPCS), and modifiers
- Experience with Medicare, Medicaid, and commercial payer guidelines
- Familiarity with EHR systems and billing software (e.g., Athena, Kareo, AdvancedMD)
- Proficiency in Microsoft Excel and basic data entry/reporting tools
- Excellent communication skills and attention to detail
- Ability to work independently and manage multiple billing priorities
Sponsorship
This position is not eligible for employment sponsorship (Green Card holders and U.S. Citizen only)
Required Skills
- Certification in medical billing and coding (e.g., CPC, CPB)
- Prior experience in wound care billing or durable medical equipment (DME) claims
- Knowledge of documentation requirements for advanced wound therapies
Preferred Skills
- Certification in medical billing and coding (e.g., CPC, CPB)
- Prior experience in wound care billing or durable medical equipment (DME) claims
- Knowledge of documentation requirements for advanced wound therapies
Pay range and compensation package
- Competitive salary based on experience
- Health, dental, and vision insurance
- 401(k) plan
- Paid time off and holidays
- Professional development opportunities
Equal Opportunity Statement
We are committed to diversity and inclusivity in our hiring practices.
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