Claims Reconciliation Specialist

DescriptionThe Claims Reconciliation Specialist is responsible for comprehensive billing procedures and verification prior to coding for anesthesia services. This role ensures accurate documentation collection, provider verification, and compliance with medical direction requirements to maximize revenue recovery. This is a full-time position based at our corporate office in Addison, TX, reporting to the Intake/Scrubbing Lead. This role requires on-site presence during regular business hours.

Key Responsibilities

Documentation and Verification

Documentation Collection: Ensure receipt of complete anesthesia records including pre-anesthesia evaluation, intraoperative records, PACU documentation, and addendums

Provider Verification: Confirm all applicable providers are properly identified with supervising and rendering provider details

Case Details Review: Validate date of service, facility information, and cross-check surgeon details against anesthesia records

Time Accuracy Review: Verify anesthesia start/stop times, document breaks and hand-offs, ensure consistency across cases

Compliance and Coding

Medical Direction Compliance: Ensure seven required elements are documented including pre-anesthesia evaluation, presence at induction, monitoring, availability, emergence, post-anesthesia care, and 4:1 supervision ratio

Modifier Verification: Confirm correct ASA status assignment and anesthesia modifiers

Supporting Documentation: Verify documentation supports additional procedure codes for pain blocks, line placement, and ultrasound guidance

Administrative Tasks

Insurance Verification: Confirm patient eligibility and obtain required authorizations

Charge Ticket Review: Ensure anesthesia records align with internal charge tickets

Batch Management: Verify case counts and upload complete batches for data entry team

Required Qualifications

High school diploma or equivalent; associate degree in healthcare administration preferred

2+ years of experience in medical billing, particularly anesthesia billing

Knowledge of CPT, ICD-10, and anesthesia-specific coding (ASA base units, time units, modifiers)

Understanding of medical direction vs. medical supervision billing requirements

Familiarity with CMS guidelines for concurrent care limitations

Proficiency in practice management software and electronic health records

Strong attention to detail and analytical skills

Excellent communication and problem-solving abilities

At OrthoMed, you'll be part of a team dedicated to excellence in patient care. We offer competitive compensation, health/dental/vision insurance, 401(k) with 3% non-discretionary company contributions, professional development opportunities, and a fun collaborative work environment.

Join us in our mission to elevate healthcare standards and make a lasting impact. Apply now to become an integral part of our dynamic team!