Commercial Billing Lead in Clifton, New Jersey at Progressive Spine and Orthopaedics LLC

JOB TITLE: Billing Lead (Commercial)
COMPANY: Progressive Billing
PAY Range: OPM Pay Grade 10 (Hourly)
FLSA Status: Non-Exempt

SUMMARY: The Commercial Billing Lead serves as the senior operational resource for the Commercial Billing Department and acts as the primary liaison between billing staff and leadership. The Lead oversees daily workflow coordination, provides technical guidance, assists with training and quality assurance initiatives, and supports department performance objectives. This position performs advanced billing functions while helping ensure productivity, accuracy, and compliance throughout the commercial billing operation.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Workflow Coordination
Coordinate daily work assignments and account distribution within the commercial billing team.
Monitor work queues, productivity, and aging reports.
Assist in prioritizing workload to ensure timely claim resolution.
Communicate workflow concerns and operational challenges to management.

Advanced Billing & Collections
Manage the department's most complex commercial and OON accounts.
Resolve escalated denials, underpayments, and reimbursement disputes.
Assist staff with payer escalations and difficult claim resolutions.
Serve as a resource for advanced billing and reimbursement questions.

Team Support & Training
Assist with onboarding and training of new employees.
Provide ongoing coaching and technical guidance to staff.
Reinforce department policies, procedures, and payer updates.
Identify training opportunities and communicate development needs to management.

Quality Assurance
Conduct routine quality reviews of billing activities.
Monitor claim accuracy, follow-up compliance, and documentation standards.
Identify trends contributing to denials or delayed reimbursement.
Recommend process improvements to enhance efficiency and accuracy.

Reporting & Operational Support
Prepare and analyze operational reports related to AR, denials, appeals, collections, and productivity.
Assist leadership in tracking departmental performance metrics.
Participate in special projects and process improvement initiatives.
Support implementation of workflow enhancements and system changes.

Vendor
Assist with oversight of third-party negotiation activity.
Monitor negotiated account outcomes and reimbursement compliance.
Coordinate communications with commercial payers and vendors regarding escalated issues.
Track recurring payer trends and report findings to leadership.

QUALIFICATIONS:
High school diploma or equivalent required.
Associate or Bachelor's degree preferred.
Minimum 5–7 years of commercial medical billing experience.
Extensive experience with commercial and out-of-network reimbursement.
Prior experience serving as a trainer, mentor, or senior team resource preferred.
Expert-level knowledge of commercial billing operations.
Strong leadership and coaching abilities.
Advanced denial management and appeals expertise.
Strong reporting and analytical capabilities.
Excellent communication and organizational skills.

PHYSICAL DEMANDS AND WORK ENVIRONMENT
This position operates within a professional office environment and requires extensive computer use, telephone communication, and prolonged periods of sitting. Occasional overtime may be required based on operational needs.

DOL / FLSA CLASSIFICATION JUSTIFICATION
Based on an evaluation of the actual duties performed, the Commercial Billing Lead is classified as non- exempt under the Fair Labor Standards Act and applicable state wage and hour laws. Although the position provides workflow coordination, technical leadership, training assistance, and operational support, the primary duty remains the performance of advanced commercial billing, collections, reimbursement recovery, and revenue cycle functions.

The position does not have authority to hire, terminate, discipline, promote, or independently make personnel decisions and does not manage a recognized department as its primary function. Any leadership responsibilities are performed in support of management rather than as true managerial authority. Accordingly, the position does not meet the requirements of the Executive, Administrative, or Professional exemptions and remains eligible for overtime compensation under federal and state law.

The above is intended to describe the general content of and requirements for the performance of this job. 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 accommodations may be made to enable individuals with disabilities to perform the essential functions.