Surgical Commercial Billing & Collections Specialist

Medical Billing & Collections Specialist (Commercial & Out-of-Network Surgical Focus) Full-Time | Monday–Friday | Clifton, NJ$26-30/hr | Benefits including pension, 401k, PTO & moreAbout 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.You’ll 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 You’ll 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 We’re 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. You’ll gain deep exposure to complex commercial payer strategies, out-of-network reimbursement negotiation, and high-dollar surgical billing workflows in a specialized clinical environment.