Medical Billing & Collections Representative in Clifton, New Jersey at Progressive Spine and Orthopaedics LLC

Position Summary:
The Medical Billing & Collections Representative is responsible for managing the full collections process for medical claims, with a specialized focus on commercial insurance carriers, out-of-network (OON) claims, and vein-related procedures.
The ideal candidate will have in-depth experience with complex reimbursement structures, vein procedure coding, and claims resolution, ensuring accurate payment and compliance with payer policies.

Key Responsibilities:
Collections & Follow-Up:
- Monitor and follow up on unpaid or underpaid claims, particularly from commercial carriers and OON payers, with emphasis on vein-related procedures (e.g., ablations, sclerotherapy, phlebectomy).
- Communicate with insurance companies, providers, and patients to ensure timely resolution of outstanding balances.
- Manage claim denials, including procedure-specific denials, by preparing and submitting timely, well-documented appeals.
- Collaborate with management and coding teams to ensure accurate CPT and ICD-10 coding for vein treatments.

Dispute Resolution:
- Investigate and resolve OON reimbursement issues for vein procedures to secure appropriate payment.
- Negotiate with insurance companies for fair reimbursement on complex or high-cost vascular treatments.
- Maintain up-to-date knowledge of vein procedure codes, payer medical policies, and appeal guidelines.

Patient Communication:
- Explain billing statements, vein procedure charges, and OON patient responsibilities in a clear and professional manner.
- Assist patients with establishing payment plans or financial arrangements for high-cost treatments.

Documentation & Reporting:
- Maintain accurate, detailed records of all billing and collection activities related to vein services.
- Generate reports on outstanding claims, denials, appeals, and aging for management review.

Insurance Reconciliation:
- Reconcile carrier payments against submitted vein procedure claims.
- Process necessary adjustments and write-offs per established billing and compliance policies.

Required Skills & Qualifications:
Experience:
- 3–5 years of medical billing and collections experience with a focus on commercial carriers (e.g., BCBS, Aetna, UnitedHealthcare) and out-of-network claims.
- Prior experience in vein or vascular billing (ablation, sclerotherapy, ultrasound-guided procedures) strongly preferred.
- Familiarity with ICD-10, CPT, and HCPCS coding specific to vein treatments.
Strong understanding of OON reimbursement structures and vein-specific payment challenges.

Technical Proficiency:
- Proficient in medical billing software and EHR/claims management systems.
- Knowledge of HIPAA regulations and confidentiality best practices.

Communication Skills:
-Excellent written and verbal communication skills when working with carriers, providers, and patients.
-Ability to clearly explain insurance and billing details, particularly for specialized vein procedures.

Problem-Solving:
-Strong analytical skills to identify trends, correct discrepancies, and resolve billing issues efficiently.
-Ability to manage multiple priorities in a fast-paced environment while meeting deadlines.

Education:
- High school diploma or equivalent required.
- Associate’s or Bachelor’s degree in Healthcare Administration, Business, or related field preferred.

Work Environment:
- Office-based, standard working hours.
- Occasional overtime may be required to meet deadlines or resolve urgent issues

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.