Job Description

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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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