Medical Billing & Collections Specialist (Commercial & Out-of-Network Surgical Focus)
Full-Time | MondayFriday | Clifton, NJ
$26-30/hr | Benefits including pension, 401k, PTO & more
About the RoleWe are seeking an experienced Medical Billing & Collections Specialist to manage the full revenue cycle for high-value surgical claims within a specialty surgical environment. This role focuses heavily on commercial insurance and out-of-network reimbursement, with a strong emphasis on complex denial management, appeals, and payer negotiation.
Youll be working in a fast-paced, specialty-driven setting supporting neuro-spine, orthopedic, and podiatry surgical billing where accuracy, persistence, and strong payer knowledge directly impact reimbursement outcomes.
What Youll Do- Manage end-to-end billing and collections for commercial and out-of-network surgical claims
- Follow up on unpaid and underpaid claims, particularly high-dollar surgical procedures
- Investigate, appeal, and resolve complex claim denials
- Communicate with insurance carriers, providers, and patients to resolve billing issues
- Negotiate reimbursement outcomes for out-of-network and underpaid claims
- Review and interpret Explanation of Benefits (EOBs) and payer policies
- Reconcile payments and ensure accurate claim resolution
- Maintain detailed records of billing activity, appeals, and collection efforts
- Support patients with billing questions and payment plan options
What Were Looking For- 5+ years of medical billing and collections experience
- Strong background in commercial insurance billing required
- Out-of-network (OON) billing experience strongly preferred
- Experience with surgical specialties such as neuro-spine, orthopedics, or podiatry required or highly preferred
- Strong understanding of ICD-10, CPT, and HCPCS coding
- Experience handling appeals, denials, and payer negotiations
- Proficiency with billing systems and Microsoft Excel
Nice to Have- Experience in specialty surgical practices or high-volume provider groups
- Familiarity with reimbursement disputes and contract variance resolution
- Prior experience working complex A/R aging reports
Why This Role Stands OutThis is a high-impact billing role focused on specialty surgical claims where your work directly influences revenue recovery. Youll gain deep exposure to complex commercial payer strategies, out-of-network reimbursement negotiation, and high-dollar surgical billing workflows in a specialized clinical environment.