Billing Manager

SpineSearch is seeking a detail-oriented and proactive
Billing Manager
to join a pain and spine practice in Somerset County. This role is essential in ensuring accurate insurance verification, effective claims management, and clear communication with patients, attorneys, billing partners, and internal departments. The ideal candidate has strong organizational skills, excellent follow-through, and prior experience working with medical billing, insurance verification, or revenue cycle workflows.

Key Responsibilities

Insurance Verification & Patient Communication

• Review the schedule at least one week in advance to verify insurance for all new patients.
• Update billing alerts in the EMR and coordinate with the marketing team and third-party scheduling partners for incoming new patients.
• Contact patients to review their benefits and clearly explain financial responsibilities.
• Update co-payments and other insurance-related data for major medical patients.

Claims, Billing Support & Documentation

• Assist with NSA (No Surprises Act) claims, including collecting all required documentation (EOB, AOB, medical notes).
• Support billing queries by updating logs and working claims through the billing → claims → log workflow.
• Follow up on major medical claims requiring reprocessing.
• Assist the billing department with insurance-related questions and claim escalations.
• Manage claims marked "paid to patient," including updating claim statuses and researching payment details.

Statements, Fee Schedules & Legal Requests

• Prepare itemized fee schedule statements for LOPs (Letters of Protection) and settlements.
• When attorneys request fee schedules before issuing an LOP, coordinate with ASC and Anesthesia to gather required fee schedules.

Mail Management & Documentation Handling

• Sort incoming mail by date range and distribute appropriately based on claim type and billing contact.
• Separate checks by entity and ensure accurate processing.
• Process medical records and narrative requests, including copying accompanying checks and uploading documents to the patient chart.
• Review all EOBs and escalate or resolve payment discrepancies as needed.

Negotiations & Reimbursement Review

• Support settlement or claim negotiations by reviewing the patient's insurance verification and comparing reimbursement rates.
• Utilize to determine out-of-network benchmarks (based on zip code and negotiate for at least 80–85% of the fair health value.

File Uploads & Administrative Support

• Upload required documentation to external portals and partner entities.
• Provide general administrative support to ensure smooth billing and insurance operations.

Qualifications

• Experience in medical billing, insurance verification, or revenue cycle preferred.
• Strong communication skills with the ability to explain insurance benefits to patients.
• High attention to detail and ability to manage multiple tasks efficiently.
• Familiarity with EMRs and claim management systems.
• Ability to problem-solve insurance issues and follow through on claim resolution.