Medical Billing and Coding Specialist

Full-Time | In-Person | Healthcare Administration 

New Jersey Brain and Spine is a neurosurgical group in northern New Jersey with multiple locations specializing in the operative and non-operative management of a variety of neurological conditions. The center offers specialty services in spinal surgery and medicine, neurovascular disease, movement disorders, pain and palliative neurosurgery, neuro-oncology and skull-base surgery, gamma knife radiosurgery, Chiari malformation and hydrocephalus, and pediatric neurosurgery.

Position Summary:

We are seeking an experienced Medical Billing and Coding Specialist to join our practice’s billing department, with a primary focus on neurosurgery and pain management services. This role requires strong expertise in physician practice billing and coding, with a minimum of three years of hands-on experience; five or more years is strongly preferred. The selected candidate will play a key role in ensuring accurate coding, timely claims submission, effective resolution of billing issues, and supporting the development of efficient processes to optimize overall revenue cycle performance.

Responsibilities:

• Manage lockbox services, ERA, EFT, and other payment processing systems.
• Experience with Echo, Payspan, Jopari, Virtual Credit Cards, or similar services is a plus.
• Obtain prior authorizations for surgical procedures by coordinating with providers, payers, and clinical staff to ensure medical necessity requirements are met prior to the date of service.
• Track and manage surgical authorizations from submission through approval, verifying authorization accuracy, validity dates, and procedure codes to ensure services are fully authorized before scheduling and billing.
• Access and review hospital EMR records, including operative reports and consults, to validate clinical documentation and assign appropriate ICD-10, CPT, and HCPCS codes for accurate authorization and billing.
• Submit insurance claims in a timely manner, ensuring accuracy and compliance with payer guidelines.
• Follow up on unpaid or denied claims, utilizing appropriate methods to resolve discrepancies and ensure optimal reimbursement.
• Collaborate with the revenue cycle team to ensure efficient collections and accurate payment posting.
• Communicate effectively with insurance companies, patients, and clinical staff to resolve billing and coding issues.
• Stay up to date with changes in coding standards, payer-specific policies, and relevant healthcare regulations, including the No Surprise Act.
• Participate in audits and quality control processes to ensure compliance with industry standards and payer requirements.

Qualifications:

• Minimum of 3 years of experience in medical billing and coding, with a preference for candidates with 5 years of experience.
• Strong expertise in coding and insurance claim requirements.
• Proficiency in ICD-10, CPT, and HCPCS coding systems.
• Experience with insurance verification, claim submission, and follow-up processes.
• In-depth knowledge of insurance payer policies, including out-of-network reimbursement practices.
• Familiarity with Electronic Health Record (EHR) systems, preferably EClinicalWorks (ECW) and Epic.
• Proficiency in Excel spreadsheets and PowerBI is essential
• Excellent attention to detail and organizational skills.
• Strong communication and interpersonal skills for effective collaboration with clinical teams, patients, and insurance providers.
• Knowledge of healthcare regulations, including the No Surprise Act, is highly preferred.
• Medical billing and coding certification (e.g., CPC, CCS) is preferred but not required.
• Benefits: We offer a competitive salary, a comprehensive benefits package, and opportunities for professional growth within a dynamic and expanding neurosurgical practice.

Benefits:

• 401(k)
• Dental insurance
• Flexible Spending Accounts
• Accident, Hospital, Critical Illness Insurance
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Vision insurance