PIP Surgery Collector

Job Description

Job Description

Description

PIP Surgery Collections Specialist  

Personal Injury Protection (PIP) | High-Dollar Surgical Claims | Out-of-Network Expertise Preferred  

As a PIP Surgery Collections Specialist, you will play a critical role in maximizing reimbursement for complex, high-dollar surgical claims. This position is designed for highly motivated revenue cycle professionals who enjoy solving challenging reimbursement issues, conducting in-depth claim investigations, and pursuing denied or underpaid claims through resolution. 

You will work directly with insurance carriers, attorneys, regulatory agencies, and internal stakeholders to secure appropriate reimbursement for surgical services including spine surgery, orthopedic procedures, pain management injections, and related specialties. Success in this role requires persistence, analytical thinking, strong knowledge of PIP regulations, and a passion for uncovering revenue opportunities others may overlook. 

At our organization, every denied claim represents an opportunity to recover revenue, improve processes, and support exceptional patient care. 

High-Dollar Claim Resolution  

• Manage and resolve complex, high-balance surgical accounts involving Personal Injury Protection (PIP) and Motor Vehicle Accident claims. 
• Investigate underpayments, denials, reductions, fee schedule discrepancies, and carrier reimbursement issues. 
• Develop and execute collection strategies to maximize reimbursement and accelerate account resolution. 

Denial Management & Appeals  

• Analyze explanations of benefits (EOBs), payer correspondence, and claims history to identify reimbursement opportunities. 
• Prepare and submit detailed appeals, reconsiderations, arbitration filings, and supporting documentation. 
• Pursue denied claims through all available avenues including carrier escalation, arbitration, attorney involvement, and regulatory remedies when appropriate. 

Regulatory & Compliance Expertise  

• Maintain working knowledge of New Jersey and New York PIP regulations, fee schedules, timely filing requirements, and arbitration processes. 
• Stay current on changes affecting motor vehicle claims, no-fault reimbursement, and out-of-network billing practices. 
• Ensure all collection activities are compliant with applicable federal and state regulations. 

Insurance & Attorney Follow-Up  

• Conduct strategic follow-up with insurance carriers, third-party attorneys. 
• Research claim issues, obtain missing information, and remove barriers to payment. 
• Build and maintain productive relationships with payer representatives and legal contacts. 

Account Investigation & Revenue Recovery  

• Perform detailed account analysis to identify billing errors, coding issues, payer processing errors, exhausted benefits, coordination of benefits concerns, and other reimbursement obstacles. 
• Review aging accounts and develop recovery strategies for difficult or previously unresolved claims. 
• Identify trends and opportunities for revenue improvement. 

Documentation & Reporting  

• Maintain accurate and detailed account notes documenting all collection efforts, payer communications, and claim status updates. 
• Track productivity, collection of performance, and account outcomes. 
• Utilize payer portals, billing systems, and reporting tools to effectively manage workflows. 

Basic Qualifications  

• Strong passion for identifying and recovering revenue on complex accounts. 
• Exceptional investigative and problem-solving skills. 
• Ability to independently manage a demanding portfolio of accounts. 
• Excellent organizational skills with strong attention to detail. 
• Strong verbal and written communication skills. 
• Ability to prioritize high-dollar accounts and work efficiently in a fast-paced environment. 
• Driven, persistent, and results-oriented mindset. 

Experience Requirements  

Required Experience  

• Minimum of 2+ years of medical billing and collections experience. 
• Proven success resolving denied, underpaid, and high-balance medical claims. 
• Experience working complex accounts receivable and insurance follow-up. 
• Strong understanding of revenue cycle management and reimbursement practices. 

Preferred Experience  

• Personal Injury Protection (PIP) collections experience. 
• Experience collecting on surgical claims and high-dollar accounts. 
• Knowledge of New Jersey and New York No-Fault/PIP regulations. 
• Experience with arbitration filings and dispute resolution processes. 
• Out-of-Network billing and reimbursement experience. 
• Familiarity with major commercial insurance carriers and payer portals. 
• Experience working with attorneys and legal representatives. 

Specialty Experience Strongly Preferred  

• Spine Surgery 
• Orthopedic Surgery 
• Pain Management 
• Interventional Pain Procedures/Injections  
• Physical Medicine & Rehabilitation (PM&R) 

Technical Skills  

• Proficiency in Excel and/or Google Sheets. 
• Experience working within billing systems, EMRs, and payer portals. 
• Ability to analyze claim data and reimbursement trends. 

What Makes Someone Successful in This Role  

The ideal candidate is someone who enjoys a challenge, refuses to accept incorrect denials at face value, and has the persistence to pursue every reimbursement opportunity available. They are naturally curious, analytical, and resourceful, with the ability to investigate complex claim scenarios and recover revenue that others may overlook. 

If you're the type of collector who enjoys digging into difficult cases, challenging payer decisions, and winning reimbursement on high-dollar surgical claims, we'd love to hear from you.  

This version should attract the type of collector you're looking for: experienced in PIP, surgery, high-dollar AR, NJ/NY no-fault regulations, investigations, arbitration, and aggressive revenue recovery , rather than a traditional medical billing collector.