Description
The Role
We're looking for an experienced Medical Biller who understands the nuances of out-of-network commercial billing and the federal and/or state Independent Dispute Resolution (IDR) process. You'll manage claims and disputes where the rules are anything but standard — open negotiation periods, eligibility determinations, jurisdictional routing, and reconsiderations — and help our clients recover what they're owed.
This is a hands-on role for someone who is detail-driven, comfortable with payer policy, and enjoys solving the puzzles that come with surprise billing law and out-of-network reimbursement.
What You'll Do
Prepare, submit, and follow up on out-of-network commercial claims across multiple payers
Manage IDR cases through federal, NY State, and/or NJ tracks — including open negotiation, eligibility review, objections, and reconsiderations
Determine the correct dispute pathway based on plan type, facility network status, and consent/waiver rules
Track deadlines and submission windows carefully to protect every claim
Work denials, appeals, and underpayments to resolution
Maintain accurate documentation and clear status updates for clients and internal teams
Collaborate with billing, coding, and account management colleagues to keep cases moving
Requirements
- 1-2 Years of Medical Billing Experience
- Hands-on medical billing experience, ideally in a specialty, surgical, or RCM setting
- Working knowledge of out-of-network commercial billing
- Familiarity with the federal No Surprises Act IDR process and/or state IDR programs (NY and/or NJ a plus)
- omfort interpreting payer policy, EOBs, and plan eligibility rules
- Strong organizational skills and attention to deadlines
- Clear, professional communication — written and verbal
