Claims Creation

Job Description:

· Claim Intake & Generation: Review electronic health records (EHR) and clinical documentation to initiate, format, and generate medical claims.

· Ability to work independently

· Excellent written and verbal communication skills

· Ability to multitask and prioritize effectively in a fast-paced environment.

· Medical Coding Alignment: Verify and apply standardized ICD-10-CM diagnosis codes, CPT procedure codes, and HCPCS codes to ensure clinical accuracy.

· Insurance Verification: Confirm patient demographic details, active policy coverage, primary/secondary insurance sequencing, and prior authorizations.

· Quality & Edit Reviews: Run claims through automated software "scrubbers" to catch missing modifiers, incorrect demographic info, or mismatched codes before final submission. · Compliance: Maintain strict confidentiality and adhere to all HIPAA privacy rules and federal billing regulations.

· Knowledge: Basic understanding of insurance policies, medical terminology, or legal guidelines depending on the industry

· Attention to detail and able to take initiative to resolve discrepancies with coding or claims issues.

Skills and Requirements:

· Education: High school diploma or equivalent; an associate degree or certificate in medical billing and coding is highly preferred.

· Software Proficiency: Hands-on experience with healthcare billing software and systems (e.g., Epic, eClinicalWorks, or Athena).

· Core Competencies: High data-entry speed and accuracy, strong medical terminology familiarity, knowledge of commercial insurance and government policies (Medicare/Medicaid), and precise analytical skills

Orthopaedic Solutions Management is a Drug Free Workplace

We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy.