Medical Billing and Collections Representative

Job Description

Job Description

Job Title : Medical Billing Collections Representative (Commercial, Out-of-Network NJ & Spine / Orthopedic Experience)

Position Summary :

The Medical Billing Collections Representative is responsible for the collections process for medical claims, with a specialized focus on commercial insurance carriers, out-of-network (OON) claims, and spine / orthopedic procedures.

The ideal candidate will have expertise in navigating complex insurance policies, understanding orthopedic / spinal procedures, ensuring timely payment, and resolving discrepancies between healthcare providers and insurance companies.

Key Responsibilities :

Collections and Follow-up :

• Proactively monitor and follow up on unpaid or underpaid claims, particularly those from commercial insurance carriers and out-of-network payers, focusing on orthopedic and spine-related claims.
• Communicate effectively with insurance companies, providers, and patients to ensure timely resolution of outstanding balances, including those for high-cost spine and orthopedic treatments.
• Manage claim denials, including those specific to spine and orthopedic services, by working with insurance carriers to resolve issues and submit timely appeals.
• Collaborate with Management and the coding team to ensure correct coding for spine and orthopedic-specific procedures (e.g., spinal fusions, joint replacements, etc.).

Dispute Resolution :

Patient Communication :

Documentation and Reporting :

Insurance Reconciliation :

Required Skills and Qualifications :

Experience :

Technical Proficiency :

Communication Skills :

Problem Solving :

Education :

Work Environment :

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.

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