Claims Reconciliation Specialist

Key Responsibilities

• Documentation and Verification
• Ensure receipt of complete anesthesia records including pre-anesthesia evaluation, intraoperative records, PACU documentation, and addendums
• Confirm all applicable providers are properly identified with supervising and rendering provider details
• Validate date of service, facility information, and cross-check surgeon details against anesthesia records
• 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

About the Role

This is a full-time position based at our corporate office in Addison, TX, reporting to the Scheduling/Intake/Scrubbing Lead. This role requires on-site presence during regular business hours.

Benefits

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.

Pay

Competitive compensation

Schedule

Full-time position based at our corporate office in Addison, TX, requiring on-site presence during regular business hours.