Senior Revenue Cycle Specialist Clinicspectrum Inc Union, NJ Job Details Full-time $22 - $28 an hour 2 hours ago Benefits Paid holidays Health insurance Dental insurance 401(k) Paid time off Vision insurance Life insurance Retirement plan Qualifications Appeals Spanish Teamwork Legal correspondence preparation National Correct Coding Initiative (NCCI) guidelines Medicare Motor vehicle insurance law Insurance dispute resolution CMS Regulatory compliance in claims processing Practice management software Patient management software English Workers' compensation insurance knowledge Certified Professional Coder CMS regulatory compliance Medicare regulations Insurance claims arbitration Centers for Medicare & Medicaid Services (CMS) billing regulations Medical claims submission Insurance claims appeal handling Full Job Description

NOW HIRING

Senior Revenue Cycle Specialist - Workers' Compensation | No-Fault | Auto | Out-of-Network & IDR Union, NJ (On-Site) | Full-Time | 10+ Years Experience Required About Clinicspectrum Inc. Clinicspectrum Inc. is a nationally recognized healthcare revenue cycle management and practice consulting firm headquartered in Union, NJ. We serve 1,800+ medical groups, 27+ billing companies, and employ over 90 US-based specialists and 750+ back-office professionals. Our proprietary platforms — InvoiceSpectrum™, CredentialingSpectrum™, and RPASpectrum™ — power cutting-edge RCM operations for hospitals, surgical centers, and specialty practices across the country. Position Summary We are seeking a seasoned Subject Matter Expert (SME) in specialty billing to join our high-performing RCM team. The ideal candidate brings deep, hands-on expertise in Workers' Compensation (WC), No-Fault (NF), Auto/PIP, and Out-of-Network (OON) billing, with direct experience navigating the Independent Dispute Resolution (IDR) process under the No Surprises Act. This is a senior-level individual contributor and team resource role — you will be the go-to authority on complex billing, appeals, and dispute resolution. Key Responsibilities

• Manage end-to-end billing and collections for Workers' Compensation, No-Fault, Auto/PIP, and Out-of-Network claims across multiple client practices
• Lead and execute the Independent Dispute Resolution (IDR) process under the No Surprises Act, including initiating disputes, preparing supporting documentation, and managing timelines
• Draft, submit, and track WC C-4/C-4.

2, NF-3, and

HCFA/CMS-1500

claim forms in accordance with applicable state and federal regulations (emphasis on New York and New Jersey jurisdictions)

• Respond to and appeal WC Board decisions, fee schedule disputes, and No-Fault denials through formal arbitration processes (AAA, DFS arbitration, WCAB hearings, etc.)
• Oversee Out-of-Network billing strategy including surprise billing compliance, Good Faith Estimate (GFE) preparation, and OON negotiation
• Identify underpayments, denials, and billing errors; develop and execute corrective action plans
• Serve as internal subject matter expert and trainer for billing staff on WC, NF, Auto, and OON processes
• Collaborate with physicians, practice managers, and legal teams on complex cases and disputes
• Monitor regulatory updates (NY WC Board, NJ

DOBI, CMS IDR

rules) and ensure compliance across all client workflows

• Produce performance reports, AR metrics, and dispute resolution outcome tracking for leadership Required Qualifications
• Minimum 10 years of direct, hands-on experience in Workers' Compensation, No-Fault, Auto/PIP, and Out-of-Network medical billing — no exceptions
• Demonstrated expertise in the IDR (Independent Dispute Resolution) process under the No Surprises Act — must have personally managed IDR submissions and outcomes
• Deep knowledge of NY WC Board rules, NYS No-Fault regulations (11 NYCRR 65), NJ PIP statutes, and federal OON billing regulations
• Proficiency with WC and NF claim forms: NF-3, NF-AOB, C-4, C-4.2, CMS-1500, and UB-04
• Experience with fee schedule analysis (NY WC Medical Fee Schedule, NJ DMAHS, Medicare RBRVS)
• Working knowledge of arbitration processes (AAA No-Fault arbitration, DFS arbitration, WCAB hearings)
• Strong understanding of NCCI edits and

CPT/ICD-10

coding as they apply to WC and NF billing

• Familiarity with practice management systems (eClinicalWorks, Kareo, AdvancedMD, or similar)
• Exceptional written and verbal communication skills — ability to draft demand letters, appeals, and dispute narratives Preferred / Bonus Qualifications
• CPC, CPCO, or equivalent billing/coding certification
• Experience in a multi-client billing company or RCM outsourcing environment
• Prior supervisory or training experience in WC/NF billing departments
• Exposure to lien resolution and attorney involvement in WC/NF cases
• Bilingual (English/Spanish) a plus What We Offer
• Competitive salary commensurate with experience — we pay for true expertise
• On-site position based at our Union, NJ office
• Health benefits, PTO, and paid holidays
• Collaborative, fast-paced environment with exposure to a diverse client portfolio
• Opportunity to build and lead a specialty billing division
• Direct access to senior leadership with a clear path to a department head role How to Apply Submit your resume and a brief cover letter outlining your specific WC, No-Fault, Auto, OON, and IDR experience to: 908.

834.1608 2184 Morris Avenue, Floor 2, Union, NJ 07083 www.clinicspectrum.com

Pay:

$22.00 - $28.00 per hour

Benefits:

401(k) Dental insurance Health insurance Life insurance Retirement plan Vision insurance

Work Location:

In person