Job Description

Role & responsibilities Job Summary: The Wound Care Billing Specialist is responsible for accurately processing medical claims related to wound care treatments and procedures. This role ensures compliance with insurance regulations, optimizes reimbursement, and resolves billing discrepancies. The specialist works closely with healthcare providers, insurance companies, and patients to facilitate smooth billing operations. Key Responsibilities: Billing & Claims Processing: Accurately code and submit wound care claims to insurance companies (Medicare, Medicaid, and private insurers). Ensure proper use of CPT, HCPCS, and ICD-10 codes specific to wound care procedures. Review and verify documentation to support claims submission. Process claims in a timely manner to maximize reimbursements. Revenue Cycle & Reimbursement: Monitor claim status and follow up on unpaid or denied claims. Investigate and appeal claim denials related to wound care services. Ensure claims are submitted with proper modifiers and documentation to avoid rejections. Assist in resolving discrepancies related to payments, adjustments, and contractual write-offs. Compliance & Documentation: Maintain compliance with HIPAA, Medicare, Medicaid, and payer-specific guidelines. Ensure all billing practices align with federal and state regulations. Keep up to date with changes in wound care billing regulations and coding updates. Work closely with providers to ensure accurate documentation for billing purposes. Patient & Provider Support: Communicate with patients regarding billing inquiries and insurance coverage. Assist providers and clinical staff in understanding billing processes and documentation requirements. Educate patients on out-of-pocket costs and assist with financial arrangements if needed. Qualifications & Skills: Education: High school diploma or equivalent (Associates or Bachelor's degree preferred). Experience: 3+ years of medical billing experience, preferably in wound care, dermatology, or related specialties. Certifications: Certified Professional Coder (CPC), Certified Medical Reimbursement Specialist (CMRS), or similar certification is a plus. Technical Skills: Proficiency in medical billing software (e.g., Epic, Kareo, Athenahealth, or similar). Strong understanding of CPT, HCPCS, and ICD-10 coding for wound care. Familiarity with EOBs, claims processing, and revenue cycle management. Competencies Attention to detail and accuracy in billing and documentation. Strong communication and problem-solving skills. Ability to work independently and collaboratively within a team. Preferred candidate profile Perks and benefits