Senior-level revenue cycle specialist role focused on specialty billing for workers' compensation, no-fault, auto/PIP, and out-of-network claims. The position serves as a subject matter expert for complex billing, appeals, dispute resolution, and Independent Dispute Resolution (IDR) workflows under the No Surprises Act.
The role is based on-site in Union, NJ and supports multiple client practices across hospital, surgical center, and specialty practice settings. Responsibilities include managing end-to-end billing and collections, monitoring underpayments and denials, coordinating with physicians and legal teams, and producing AR and dispute resolution reports for leadership.
Required qualifications
- 10+ years of direct hands-on experience in workers' compensation, no-fault, auto/PIP, and out-of-network medical billing
- Demonstrated experience personally managing Independent Dispute Resolution (IDR) submissions and outcomes
- Deep knowledge of NY WC Board rules, New York no-fault regulations, New Jersey PIP statutes, and federal out-of-network billing regulations
- Proficiency with NF-3, NF-AOB, C-4, C-4.2, CMS-1500, and UB-04 claim forms
- Experience with fee schedule analysis and arbitration processes, including AAA, DFS arbitration, and WCAB hearings
- Strong understanding of NCCI edits and CPT/ICD-10 coding as applied to WC and NF billing
- Familiarity with practice management systems such as eClinicalWorks, Kareo, or AdvancedMD
- Strong written and verbal communication skills for drafting demand letters, appeals, and dispute narratives
Preferred qualifications
- CPC, CPCO, or equivalent billing/coding certification
- Prior supervisory or training experience in WC/NF billing departments
- Experience in a multi-client billing company or RCM outsourcing environment
- Exposure to lien resolution and attorney involvement in WC/NF cases
- Bilingual English/Spanish is a plus
Benefits and perks
- Competitive salary commensurate with experience
- Health benefits
- PTO and paid holidays
- 401(k)
- Dental insurance
- Vision insurance
- Life insurance
- Retirement plan
- Collaborative, fast-paced environment
- Opportunity to build and lead a specialty billing division
- Direct access to senior leadership with a path to a department head role
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
1 month ago