PIP Surgery Collector

PIP Surgery Collector

Department: RCM:
Patient Access & Billing

Employment Type: Full Time

Location: Headquarters - Matawan

Compensation: $20.00 - $30.00 / hour

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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.
• Ab…