Lead Surgical AR Representative

Spire Orthopedic Partners•Stamford, CT

11d•$29 - $44

About The Position

The Team Lead is responsible for overseeing and optimizing the reimbursement processes within the revenue cycle management framework. This role includes managing billing activities, ensuring accurate claim submission, resolving denials, and driving process improvements to maximize revenue. The specialist acts as a liaison between the billing team, payers, and other stakeholders, while providing leadership and training to team members.

Requirements

Bachelor’s degree or equivalent experience.
5+ years of experience in medical billing, claims management, or revenue cycle management, specifically orthopedic surgery with an emphasis on spine surgery.
Proven leadership experience in a healthcare or reimbursement setting.
Proficiency in billing software, EHR systems, and Microsoft Office Suite.
Strong knowledge of CPT, ICD-10, and HCPCS coding.
Exceptional analytical, organizational, and problem-solving abilities.
Strong communication and interpersonal skills for working with diverse teams.
Ability to prioritize tasks and meet deadlines in a fast-paced environment.

Responsibilities

Oversee the accurate and timely submission of claims to payers.
Ensure compliance with payer-specific guidelines and regulations.
Monitor and analyze trends in denials, rejections, and underpayments to identify improvement opportunities.
Collaborate with internal teams to resolve complex billing and coding issues.
Identify areas to enhance revenue recovery processes.
Ensure appropriate follow-up and resolution of unpaid or underpaid claims.
Review reimbursement patterns and recommend strategies for maximizing collections.
Provide guidance, training, and mentorship to reimbursement specialists.
Assign tasks, monitor productivity, and evaluate performance metrics for the team.
Foster a culture of continuous improvement and high performance.
Maintain thorough knowledge of current payer rules, government regulations, and industry standards.
Ensure all billing practices adhere to legal and regulatory requirements.
Prepare regular reports on reimbursement metrics and trends for management review.
Act as the primary point of contact for escalated reimbursement issues.
Collaborate with payers, coding staff, clinical teams and vendors to resolve discrepancies.
Participate in meetings with leadership to discuss operational challenges and solutions.