Find & Apply For Medical Biller Jobs in Robbinsville Township, New Jersey

Billing Manager -

Out-of-Network Multispecialty Healthcare Practice Location:

Robbinsville, New Jersey Employment Type:

Full-Time Department:

Revenue Cycle Management Paragon Sport Spine & Wellness is seeking an experienced and highly organized Billing Manager to oversee the complete revenue cycle operations of our out-of-network, multispecialty healthcare practice. This position will supervise and coordinate the daily work of an overseas billing team while maintaining direct accountability for billing accuracy, claims processing, accounts receivable, payment posting, claim pricing, denials, authorizations, appeals, and overall collections performance. The ideal candidate is a hands-on revenue cycle professional with strong leadership skills and experience working with multiple specialties, including: Physical Therapy Chiropractic Acupuncture Occupational Therapy Pelvic Health Therapy Interventional Pain Management This individual must understand the complexities of out-of-network billing , including appropriate claim pricing, patient responsibility, deductibles, coinsurance, reimbursement analysis, appeals, underpayments, patient-directed insurance checks, and coordination with both clinical and administrative teams. Key ResponsibilitiesBilling Team Management Oversee, manage, and assign daily responsibilities to the overseas billing team. Establish clear workflows, priorities, deadlines, and accountability standards for each billing team member. Monitor individual and team productivity, accuracy, work completion, and follow-up activity. Conduct regular billing meetings to review outstanding tasks, problem accounts, denials, aging claims, and collection priorities. Ensure work is evenly distributed and that high-priority accounts are addressed promptly. Train billing team members on practice-specific procedures, payer requirements, coding expectations, and out-of-network billing workflows. Identify performance concerns and provide coaching, corrective guidance, and follow-up. Claims Management Ensure claims are submitted accurately, completely, and within required filing deadlines. Review claims for correct patient information, insurance information, provider information, CPT codes, modifiers, diagnosis codes, units, dates of service, and place of service. Verify claims are priced appropriately based on the practice's out-of-network fee schedules and billing policies. Monitor rejected, pending, delayed, and unprocessed claims. Ensure corrected claims and reconsideration requests are submitted promptly. Identify recurring claim errors and implement systems to prevent them. Coordinate with providers and clinical staff to resolve documentation, coding, or charge-entry issues. Accounts Receivable Management Maintain a clean, accurate, and actively worked accounts receivable. Review A/R aging by payer, provider, specialty, location, and aging category. Ensure claims are consistently followed up on and do not remain untouched. Prioritize high-dollar balances, timely filing risks, aged claims, denied claims, and claims requiring appeals. Monitor unallocated payments, credit balances, unapplied funds, incorrect adjustments, and duplicate balances. Review accounts before balances are transferred to patient responsibility. Identify collection trends, reimbursement delays, and operational issues affecting cash flow. Develop action plans to reduce aging and improve collection speed. Denials and Appeals Oversee all claim denials, rejections, requests for information, and payment delays. Ensure denials are categorized, tracked, assigned, and resolved within appropriate timeframes. Prevent authorization-related, timely filing, coding, documentation, eligibility, and medical necessity denials whenever possible. Prepare or supervise the preparation of appeals, reconsiderations, medical necessity submissions, and supporting documentation. Track appeal deadlines and ensure no appeal rights are lost. Identify recurring denial patterns and work with leadership and clinical teams to correct the underlying cause. Escalate unresolved or high-value claims when additional intervention is required. Authorization and Eligibility Oversight Ensure required authorizations, referrals, and plan-of-care requirements are identified and tracked. Monitor authorization expiration dates, visit limits, approved services, and utilization requirements. Confirm that services are not provided beyond approved limits without appropriate review or patient notification. Coordinate with front desk, scheduling, and clinical staff regarding authorization concerns. Ensure authorization-related denials are investigated and addressed immediately. Maintain processes that prevent authorizations, referrals, or supporting documentation from being missed. Out-of-Network Revenue Cycle Management Apply a strong understanding of out-of-network benefits, deductibles, coinsurance, allowed amounts, usual and customary rates, and patient responsibility. Review explanations of benefits to confirm claims were processed correctly. Identify improper pricing, bundling, downcoding, underpayments, incorrect adjustments, or inappropriate denials. Ensure underpaid and incorrectly processed claims are appealed or disputed. Monitor claims involving checks issued directly to patients and coordinate appropriate patient follow-up. Work with the front desk and patient financial team to ensure patients receive accurate financial information. Assist with complex patient billing questions and disputed balances when escalation is required. Maintain consistency between insurance billing, patient statements, payment plans, and cash-rate arrangements. Payment Posting and Reconciliation Ensure insurance and patient payments are posted accurately and promptly. Review EOBs and ERAs for correct contractual adjustments, payer reductions, denials, and patient responsibility. Ensure out-of-network claims are not incorrectly adjusted as though the practice were participating with the payer. Monitor unapplied payments, unidentified deposits, credit balances, and posting errors. Reconcile deposits and payment activity with internal financial records. Work with leadership and accounting personnel to resolve discrepancies. Compliance and Quality Control Maintain compliance with HIPAA, federal and state billing requirements, payer guidelines, and practice policies. Conduct routine quality-control audits of claims, payment posting, adjustments, follow-up notes, appeals, and patient balances. Ensure billing notes are detailed, accurate, and easy for another team member to understand. Maintain organized documentation supporting billing activity and collection efforts. Ensure patient accounts are handled professionally, accurately, and confidentially. Help develop and maintain written billing policies, procedures, workflows, and standard operating procedures. Reporting and Performance Management Provide regular reports to Operations Director/owership regarding: Total collections Insurance collections Patient collections A/R aging Days in A/R Denial volume and denial reasons Outstanding authorizations Claims awaiting documentation Unbilled claims Underpayments Appeals in progress High-dollar outstanding claims Billing team productivity Collection trends by provider and specialty Identify problems before they materially affect collections. Present clear recommendations for improving reimbursement, billing efficiency, and cash flow. Establish measurable performance expectations for the billing department. Track whether assigned work is completed accurately and within established deadlines. Required Qualifications Minimum of 3 years of healthcare billing or revenue cycle management experience. Prior experience supervising or managing medical billers. Strong experience managing remote or overseas billing personnel is highly preferred. Demonstrated experience with out-of-network medical billing and collections. Experience with multiple healthcare specialties, preferably including physical therapy, chiropractic, acupuncture, occupational therapy, and pain management. Strong understanding of CPT codes, ICD-10 codes, modifiers, units, medical necessity requirements, and claim submission standards. Experience handling denials, appeals, authorizations, eligibility issues, underpayments, and aged accounts receivable. Ability to review EOBs and identify incorrect payer processing or reimbursement. Strong understanding of commercial insurance plans, deductibles, coinsurance, patient responsibility, and out-of-network benefits. Excellent organizational, analytical, communication, and leadership skills. Ability to manage multiple priorities and maintain close attention to detail. Ability to hold team members accountable while maintaining a professional and productive work environment. Proficiency with electronic medical records, practice management systems, payer portals, clearinghouses, spreadsheets, and reporting tools. Preferred Qualifications Experience working in a multidisciplinary musculoskeletal, rehabilitation, orthopedic, or pain management practice. Experience with both therapy billing and medical procedure billing. Experience billing for Medicare and commercial insurance plans. Experience with litigation-related, motor vehicle, workers' compensation, or accident-related claims is a plus. Certified Professional Biller, Certified Professional Coder, or other revenue cycle certification is preferred but not required. Experience creating billing dashboards, productivity reports, and department-level KPIs. Skills and Competencies The successful candidate will be: Highly organized and detail-oriented Proactive rather than reactive Comfortable reviewing individual patient accounts Strong at identifying patterns and solving systemic problems Capable of managing and motivating a remote team Persistent with insurance follow-up and collections Able to communicate effectively with providers, employees, patients, and insurance representatives Comfortable being held accountable for billing department performance Able to balance productivity, compliance, accuracy, and patient service Performance Expectations Success in this role will be measured by: Timely and accurate claim submission Reduction in preventable denials Improved collections and cash flow Reduced accounts receivable aging Consistent follow-up on outstanding claims Accurate claim pricing and payment posting Timely completion of appeals and authorization requirements Clean and well-documented patient accounts Improved accountability and productivity of the overseas billing team Clear, accurate, and actionable reporting to leadership Compensation and Benefits Competitive compensation will be offered based on experience, qualifications, and demonstrated revenue cycle expertise. Benefits may include paid time off, paid holidays, health insurance contributions, retirement plan participation, and opportunities for professional development. About Paragon Sport Spine & Wellness Paragon Sport Spine & Wellness is an integrated, multispecialty healthcare practice providing physical therapy, occupational therapy, pelvic health therapy, chiropractic care, acupuncture, sports medicine, and interventional pain management services. Our team is committed to delivering coordinated, high-quality care while maintaining strong operational and revenue cycle standards.

Pay:

From $24.00 per hour

Benefits:

Dental insurance Health insurance Paid time off Ability to

Commute:

Robbinsville, NJ 08691 (Required) Ability to

Relocate:

Robbinsville, NJ 08691: Relocate before starting work (Required)

Work Location:

In person