Medical Billing & Collections Specialist

Job Description Job Description

Medical Billing & Collections Specialist (Commercial & Out-of-Network Surgical Focus)

Full-Time Monday-Friday Clifton, NJ
$26-30/hr Benefits including pension, 401k, PTO & more

About the Role

We 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 Out

This 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.

Company Description HumanHire was founded on the premise that the human touch in the recruiting process is still the essential component to successful hiring. We apply a consultative approach to building client and candidate relationships. Our client-centric model allows for an unsurpassed service delivery experience.

We recognize recruiting technologies can significantly enhance our team's performance. Yet, we remain steadfast in our belief that some recruiting technologies are overhyped, and we routinely resist over-automating the talent acquisition process.

Our leadership team has over 50 years of experience as trusted industry professionals specializing in direct hire, temp to hire and temporary placements. We have cultivated long-lasting relationships and utilize them to connect our candidates and clients in several industries and job functions:

• Healthcare
• Accounting and Finance
• Human Resources
• Office and Administration
• Legal
• Real Estate
• Logistics
• Manufacturing & Engineering

We encourage you to contact us today to discuss how HumanHire can grow your career! Company Description HumanHire was founded on the premise that the human touch in the recruiting process is still the essential component to successful hiring. We apply a consultative approach to building client and candidate relationships. Our client-centric model allows for an unsurpassed service delivery experience. We recognize recruiting technologies can significantly enhance our team's performance. Yet, we remain steadfast in our belief that some recruiting technologies are overhyped, and we routinely resist over-automating the talent acquisition process. Our leadership team has over 50 years of experience as trusted industry professionals specializing in direct hire, temp to hire and temporary placements. We have cultivated long-lasting relationships and utilize them to connect our candidates and clients in several industries and job functions: • Healthcare • Accounting and Finance • Human Resources • Office and Administration • Legal • Real Estate • Logistics • Manufacturing & Engineering We encourage you to contact us today to discuss how HumanHire can grow your career!