AllSpine Pain and Wellness, located in Staten Island, NY, is seeking a highly organized and experienced Out-of-Network (OON) Biller/Collections Specialist to join our growing team. A new location in New Jersey will be opening shortly, and travel between the locations may be required. This role will focus on billing for pain management, vein treatments, anesthesia, and spine procedures. The ideal candidate will be familiar with No Surprises Act (NSA) billing, the IDR (Independent Dispute Resolution) process, and have extensive experience with New Jersey and New York PIP (Personal Injury Protection) and WC (Workers' Compensation) billing practices. You should possess strong attention to detail, exceptional problem-solving skills, and a proactive approach to ensuring timely reimbursement for services rendered.
Key Responsibilities:
- OON Billing & Collections: Manage the full spectrum of OON billing, including submission, follow-up, and collections, for services provided in pain management, vein treatments, anesthesia, and spine procedures.
- No Surprises Act (NSA) Compliance: Ensure that all billing is compliant with NSA guidelines, providing patients with clear and accurate out-of-network billing information.
- IDR Process: Handle the Independent Dispute Resolution process for contested claims in both NJ and NY, ensuring swift and effective resolution of disputes and maximizing reimbursement.
- Insurance Liaison: Work closely with insurance companies and patients to obtain accurate payment details, respond to billing inquiries, and resolve discrepancies quickly and professionally.
- Regulatory Knowledge: Maintain up-to-date knowledge of NJ and NY PIP and WC billing rules, ensuring full compliance with all state-specific regulations.
- Claims Follow-Up & Denial Management: Monitor unpaid claims, follow up on denials, and resolve payment discrepancies or underpayments in a timely manner.
- Appeals Management: Prepare and submit appeals for denied or underpaid claims, ensuring compliance with payer guidelines and using effective dispute resolution strategies.
- Record Maintenance & Reporting: Maintain comprehensive records of claims status, follow-up actions, and outcomes, providing regular reports to management.
- Cross-Department Collaboration: Collaborate with other departments (e.g., patient scheduling, coding, clinical) to ensure that billing data is accurate, complete, and up-to-date.
- Industry Knowledge: Stay informed about changes in insurance regulations, billing practices, and industry standards to ensure the practice is always compliant and optimized for success.
Qualifications:
- Experience: Minimum of 5 years’ experience in out-of-network medical billing, with expertise in pain management, vein treatments, anesthesia, and spine procedures.
- In-depth Knowledge:
- Strong familiarity with the NSA, IDR process, and out-of-network billing.
- Comprehensive understanding of NJ and NY PIP and WC billing, including claims submission, follow-up, dispute resolution, and compliance.
- Proficiency with ICD-10, CPT, and HCPCS coding systems.
- Analytical Skills: Strong ability to analyze complex billing issues, identify root causes, and implement solutions.
- Communication Skills: Excellent written and verbal communication skills to effectively interact with insurance companies, patients, and internal teams.
- Technical Skills: Proficient in using billing software, electronic medical records (EMR) systems, and other relevant tools (experience with Dr. Chrono is a plus).
- Organizational Skills: Ability to prioritize tasks, manage multiple deadlines, and maintain accuracy in a fast-paced environment.
- Detail-Oriented: Exceptional attention to detail with a focus on ensuring accuracy in billing submissions, follow-ups, and documentation.
- Problem-Solving: Strong critical thinking and troubleshooting skills to manage billing issues and resolve discrepancies effectively.
- Customer Service: A customer-centric approach, with the ability to maintain professionalism while addressing patient or insurance-related concerns.
Preferred Qualifications:
- Certification: Certified Professional Biller (CPB) or similar certification preferred.
- Software Proficiency: Experience with Dr. Chrono or similar billing software is a plus.
Work Environment:
- Location: Currently based in Staten Island, NY, with a new location opening soon in New Jersey. Some travel may be required between locations.
- Fast-paced and supportive team environment where each member plays an integral role in ensuring the success of the practice.
- Opportunities for career growth, professional development, and advancement within a newly established medical practice.
Competitive salary commensurate with experience and qualifications.