Medical Billing and Collections Representative (Commercial)

Medical Billing and Collections Representative (Commercial) Progressive Spine and Orthopaedics

LLC - 1.0

Clifton, NJ Job Details Full-time 1 day ago Benefits Opportunities for advancement Qualifications High school diploma or GED Full Job Description

JOB TITLE

Medical Billing & Collections Representative (Commercial)

COMPANY:

Progressive Billing

PAY RANGE

OPM Pay Grade 7 (Hourly)

FLSA Status:

Non-Exempt SUMMARY:

The Medical Billing & Collections Representative is responsible for managing the full lifecycle of the billing and collections process for professional medical claims, specializing in commercial insurance carriers and out-of-network (OON) reimbursement. This position focuses on ensuring accurate claim submission, timely payments, and effective resolution of denials and underpayments, particularly for Neuro Spine Surgery, Orthopaedic, and Podiatry services. The ideal candidate will bring strong analytical, negotiation, and communication skills with a solid understanding of payer policies and surgical coding.

PRIMARY DUTIES AND RESPONSIBILITIES

(but not limited to): Collections & Follow-up Monitor and follow up on unpaid or underpaid claims from commercial and OON carriers, focusing on highvalue surgical claims. Communicate with insurance carriers, providers, and patients to ensure prompt and accurate claim resolution. Research and appeal denials, including complex procedure denials, ensuring timely and compliant followup. Collaborate with internal teams to verify accurate coding and claim documentation for surgical procedures. Dispute Resolution Investigate and resolve OON reimbursement discrepancies to ensure fair and compliant payments. Negotiate reimbursements with insurance carriers and thirdparty negotiators for complex or highcost surgeries. Maintain uptodate knowledge of highfrequency surgical CPT codes, payer policies, and current reimbursement trends. Patient Communication Provide clear and professional explanations of patient statements, surgical charges, and OON responsibilities. Assist patients with setting up payment plans and answering billingrelated questions. Documentation & Reporting Maintain accurate records of all billing and collection activities for assigned specialties. Generate detailed reports on outstanding claims, denials, appeals, and payment trends for management review. Insurance Reconciliation Reconcile received payments against submitted claims to ensure proper reimbursement. Process adjustments, refunds, and writeoffs per company policies and payer guidelines.

QUALIFICATIONS

Experience 35 years of medical billing and collections experience, specializing in commercial insurance and outofnetwork billing. Prior experience in Neuro Spine, Orthopedic, or Podiatry billing required. Strong understanding of ICD10, CPT, and HCPCS coding principles. Indepth knowledge of OON reimbursement structures, EOB interpretation, and payer dispute processes. Technical Proficiency Experience with medical billing and EHR/claims management software. Proficient in MS Excel and reporting tools. Knowledge of HIPAA compliance and best practices for data security. Communication Skills Excellent written and verbal communication for interactions with carriers, patients, and providers. Strong negotiation and conflictresolution skills. Problem-Solving Analytical and detailoriented approach to identifying and resolving claim discrepancies. Ability to prioritize and manage multiple tasks in a fastpaced environment. Education High school diploma or equivalent required. Associate's or Bachelor's degree in Healthcare Administration, Business, or related field preferred.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

This is an office-based position with standard working hours from Monday through Friday. Occasional overtime may be required to meet deadlines or address urgent claim issues. The role operates within a collaborative team environment that offers opportunities for professional growth and advancement. The above is intended to describe the general content of and requirements for the performance of thisjob. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.