Medical Billing & Collections Representative

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: - 35 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. - Associates or Bachelors 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 issuesPay 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.PI9c9cf5b2e867-26289-40387632