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:- 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 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.