Coding/Billing Specialist

The Certified Coding & Billing Specialist is a foundational team member supporting both the financial sustainability and growth of Altitude Sport & Spine, a developing private practice specializing in sports medicine and spine care. This role ensures accurate coding, efficient billing, and timely reimbursement while helping establish strong revenue cycle processes during the practice’s early growth phase. As a new practice, Altitude Sport & Spine relies on clean claims, payer credibility, and a positive patient financial experience to build trust, reputation, and referral relationships in the community. The Certified Coding & Billing Specialist contributes directly to this mission by promoting billing transparency, minimizing patient confusion, reducing denials, and supporting optimized reimbursement that allows the practice to reinvest in services, technology, and patient care. This position collaborates closely with providers and leadership to develop scalable coding and billing workflows, support accurate documentation from the outset, and identify opportunities to enhance revenue integrity as service lines expand. The ideal candidate is proactive, adaptable, and motivated to help shape best practices in a growing specialty clinic while upholding the highest standards of compliance, professionalism, and patient-centered service.

Essential Duties and Responsibilities

Coding & Charge Capture

• Review clinical documentation to accurately assign CPT, ICD-10-CM, and HCPCS codes for professional services, procedures, injections, diagnostics, and ancillary services
• Ensure appropriate modifier usage and compliance with NCCI edits, LCDs, and payer-specific guidelines
• Validate medical necessity and documentation sufficiency prior to claim submission
• Collaborate with providers to clarify documentation and support accurate coding

Billing & Claims Management

• Submit clean claims to commercial, Medicare, and Medicaid payers in a timely manner
• Monitor claim status and proactively follow up on unpaid, denied, or underpaid claims
• Identify root causes of denials and implement corrective actions to prevent recurrence
• Process corrections, resubmissions, and appeals as necessary

Payment Posting & Reconciliation

• Post insurance payments, adjustments, and patient payments accurately
• Reconcile Explanation of Benefits (EOBs) with posted payments
• Identify and escalate discrepancies, underpayments, or payer variances

Compliance & Quality Assurance

• Maintain compliance with federal, state, and payer billing regulations, including HIPAA
• Stay current on coding updates, payer policy changes, and reimbursement trends
• Assist with internal and external audits, providing documentation and explanations as needed
• Support revenue cycle reporting and performance improvement initiatives

Patient & Team Support

• Respond professionally to patient billing inquiries and concerns
• Work collaboratively with front office, clinical staff, and leadership to improve workflows
• Maintain strict confidentiality of patient and financial information

Required Qualifications

Education: High School Diploma or equivalent required

Licensure / Certification (if applicable): CPC, CCS, or CBCS

Experience: 1-2 Years of experience in a medical office

Knowledge, Skills, and Abilities:

• Exceptional attention to detail and accuracy
• Strong analytical and problem-solving skills
• Ability to manage multiple tasks and deadlines independently
• Clear and professional written and verbal communication
• Collaborative mindset with a focus on continuous improvement
• Commitment to ethical billing practices and compliance

Physical and Mental Requirements

• Ability to stand, walk, and move throughout the clinic for extended periods.
• Primarily office-based work environment- potential for remote options
• Prolonged periods of sitting and computer use
• Occasional lifting of office materials up to 15 pounds