Out-of-Network Billing Specialist

Description

Title:  Out-of-network Billing Specialist

Location – Hybrid – Scheduled days at Great Neck location

Who we are: 

Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support, capital and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO), Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level, so doctors can focus their efforts on what matters most – patient care. Rooted in the 100-plus-year legacy of its founding partners, the network spans the Northeast with over 160 physicians and 300 total providers and nearly 2,000 employees, and 40 locations from Connecticut, New York, Massachusetts & Rhode Island.

Summary:

We are seeking an experienced Out-of-Network Billing Specialist with a strong background in professional orthopedic spine billing. The ideal candidate will be responsible for handling out-of-network billing, managing denials, and performing comprehensive accounts receivable (A/R) follow-up to ensure timely reimbursement and resolution of claims. This role demands expertise in navigating the complexities of out-of-network claims, including compliance with insurance regulations, negotiation of payment terms, and effective communication with insurance companies and patients.

Responsibilities/Duties:

• Out-of-Network Billing:
  • Prepare, submit, and follow up on professional orthopedic spine claims to insurance companies.
  • Ensure claims are coded and billed accurately to optimize reimbursement.
  • Verify patient insurance coverage and eligibility for out-of-network benefits.
• Denial Management:
  • Review and analyze denied or underpaid claims.
  • Identify root causes of denials and implement corrective actions to prevent recurring issues.
  • Appeal denied claims effectively to ensure maximum reimbursement.
• Accounts Receivable (A/R) Follow-Up:
  • Monitor and manage A/R aging reports for outstanding claims.
  • Conduct timely follow-ups with insurance carriers to resolve unpaid claims.
  • Negotiate payment arrangements and resolve discrepancies with insurance payers.
• Compliance and Documentation:
  • Maintain compliance with HIPAA and other regulatory standards.
  • Ensure accurate and thorough documentation of all billing and collections activities.
  • Stay updated on changes in billing codes, payer policies, and out-of-network guidelines.
• Collaboration and Communication:
  • Liaise with clinical staff, patients, and insurance companies to resolve claim-related issues.
  • Provide support to patients regarding billing inquiries and out-of-network benefits.

Qualifications

Qualifications:

• Experience: Minimum of 5 years of experience in out-of-network billing, denial management, and A/R follow-up, specifically within professional orthopedic spine billing.
• Technical Skills: Proficiency in medical billing software, coding systems (CPT, ICD-10), and electronic health records (EHR).
• Knowledge: Strong understanding of out-of-network reimbursement practices, payer policies, and industry regulations.
• Analytical Skills: Ability to analyze denial trends, A/R reports, and identify opportunities for process improvements.
• Communication: Excellent verbal and written communication skills, with the ability to negotiate effectively with insurance payers.

What we offer: 

• Excellent growth and advancement opportunities 
• Dynamic environment 
• Access to a diverse network of practitioners 
• Broad infrastructure of tools and programs to enhance the employee experience    
• Competitive Compensation 
• Generous PTO  
• Benefits package: health, dental, vision, 401(k), etc. 

We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).  
 

Salary : $23 - $29