Lead Surgical AR Representative

Who we are:

Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support, capital and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO), Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level, so doctors can focus their efforts on what matters most – patient care. Headquartered in Stamford, Connecticut, the Spire network spans the Northeast with more than 165 physicians, 1,800 employees, 285 other clinical providers and 40 locations in New York, Connecticut, Rhode Island and Massachusetts.

What you’ll do:

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.

Responsibilities/Duties:

• 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.

Who you are:

• 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.

What we offer:

• Excellent growth and advancement opportunities
• Dynamic environment
• Access to a diverse network of practitioners
• Broad infrastructure of tools and programs to enhance the employee experience
• Competitive Compensation
• Generous PTO
• Benefits package: health, dental, vision, 401(k), etc.

We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).

The final pay offered to a successful candidate will be dependent on several factors that may include but are not limited to the type and years of experience within the job, the type of years and experience within the industry, education, etc.