High Salary! Medical Billing and Collections Representative

Company: Progressive Spine and Orthopaedics LLC
Location: Englewood
Posted on: November 2, 2025

Job Description:

Job Title: Medical Billing Collections Representative (Commercial, Out-of-Network, PIP NJ & NY, & Spine/Orthopedic Experience) Position Summary: The Medical Billing Collections Representative is responsible for the collections process for medical claims, with a specialized focus on commercial insurance carriers, out-of-network (OON) claims, and spine/orthopedic procedures. The ideal candidate will have expertise in navigating complex insurance policies, understanding orthopedic/spinal procedures, ensuring timely payment, and resolving discrepancies between healthcare providers and insurance companies. Key Responsibilities: Collections and Follow-up: - Proactively monitor and follow up on unpaid or underpaid claims, particularly those from commercial insurance carriers and out-of-network payers, focusing on orthopedic and spine-related claims. - Communicate effectively with insurance companies, providers, and patients to ensure timely resolution of outstanding balances, including those for high-cost spine and orthopedic treatments. - Manage claim denials, including those specific to spine and orthopedic services, by working with insurance carriers to resolve issues and submit timely appeals. - Collaborate with Management and the coding team to ensure correct coding for spine and orthopedic-specific procedures (e.g., spinal fusions, joint replacements, etc.). Dispute Resolution: - Investigate and resolve issues related to out-of-network reimbursement rates, particularly for spine and orthopedic procedures, ensuring fair reimbursement according to industry standards or contracted rates. - Negotiate with insurance companies to secure appropriate payment for complex and high-cost spine/orthopedic services. - Maintain an understanding of orthopedic and spine treatment codes and payer policies to advocate effectively for claims. Patient Communication: - Work with patients to explain their billing statements, including detailed breakdowns of spine and orthopedic services and out-of-pocket responsibilities for out-of-network procedures. - Provide assistance in setting up payment plans or alternative billing arrangements for patients with outstanding balances, especially those for high-cost spine/orthopedic treatments. Documentation and Reporting: - Maintain accurate and up-to-date records of all billing and collection activities, specifically related to spine and orthopedic services. - Prepare detailed reports on outstanding claims, denials, appeals, and aging reports for management review. Insurance Reconciliation: - Reconcile payments received from commercial carriers, comparing payments against claims submitted for spine/orthopedic services to identify discrepancies. - Ensure that correct adjustments are made and appropriate write-offs are processed in accordance with established policies for specialized procedures. Required Skills and Qualifications: Experience: - Minimum of 5 years of experience in medical billing and collections, with specific experience handling commercial insurance carriers (e.g., Blue Cross Blue Shield, Aetna, United Healthcare) and out-of-network claims. - Previous experience working with orthopedic and spine-related procedures (e.g., spinal fusions, joint replacements, disc replacements, etc.) is a significant plus. - Familiarity with ICD-10, CPT, and HCPCS coding related to orthopedic/spine treatments. - Strong understanding of out-of-network and payer reimbursement structures, and orthopedic-specific reimbursement issues. Technical Proficiency: - Proficient in using medical billing software (e.g., Modmed). - Experience working with electronic health record (EHR) systems and claims management tools. - Knowledge of HIPAA regulations and confidentiality protocols. Communication Skills: - Strong verbal and written communication skills to interact professionally with insurance carriers, healthcare providers, and patients. - Ability to explain complex billing and insurance information in a clear and concise manner, especially in the context of orthopedic/spine procedures. Problem Solving: - Strong analytical skills to identify trends, resolve billing discrepancies, and address issues specific to orthopedic and spine claims. - Ability to manage multiple priorities in a fast-paced environment and meet deadlines. Education: - High school diploma or equivalent required; Associates or Bachelors degree in healthcare administration, business, or related field preferred. Work Environment: - Office-based standard working hours. - Standard working hours, with occasional overtime required to meet deadlines or resolve urgent claims. Pay Transparency Statement: In accordance with the New Jersey Pay Transparency Act, this role falls within Pay Grade 7 of the 2025 OPM Salary Table for the NY, NJ, CT, and PA region. Compensation is commensurate with experience and education. PI0b87f95acd8d-37156-38809199

Keywords: Progressive Spine and Orthopaedics LLC, Tenafly , High Salary! Medical Billing and Collections Representative, Accounting, Auditing , Englewood, New Jersey