Billing Representative II; Hospital Billing A​/R - Boynton , Florida

Position Summary

We have an exciting opportunity to join our team as a Billing Representative II as a part of our Hospital Billing Accounts Receivable (A/R) team. Under general direction the Billing Representative II performs intermediate-level billing and financial clearance activities, including claims submission, accounts receivable management, insurance authorizations, precertifications, and patient estimates. This role requires independent problem‑solving and supports appeals, denial management, and financial clearance for scheduled services.

• Perform billing tasks assigned by management which may include data entry, claim review, charge review, accounts receivable follow‑up, insurance authorization, patient estimates, or other related responsibilities.
• Provide input on system edits, processes, policies, and billing procedures to ensure maximization of revenues.
• Perform daily tasks in assigned work queues for claims, authorizations, and financial clearance tasks according to manager assignments.
• Identify payer, provider credentialing, and/or coding issues and address them with management.
• Follow workflows provided in training classes and request additional training as needed.
• Utilize Pathways as guide for determining actions needed to resolve unpaid or incorrectly paid claims, for authorizing procedures, or for patient estimates in assigned work queue(s) using payer websites, billing system information and training within expected timeframe.
• Review reports to identify revenue opportunities and unpaid claims.
• Adhere to general practices and departmental guidelines on compliance issues and patient confidentiality.
• Communicate with providers, patients, coders, or other responsible persons to resolve billing or clearance issues.
• Work following operational policies and procedures, and regulatory requirements.
• Participate in work groups and meetings. Attend all required training classes.
• Escalate issues to management as needed.
• Appeal complex denials through review of payer policies, coding, contracts, and medical records. Utilize subject matter experts as needed.
• Make appropriate corrections to system to satisfy/edit payer requirements and re‑submit claims as needed.
• Cross cover other areas in the office as assigned by management, including Accounts Receivable, Customer Service or Authorizations.
• Other related duties as assigned.

• Drives consistency in every patient and colleague encounter by embodying the core principles of our Billing Department Service Strategy CARES (Connect, Align, Respond, Ensure, and Sign‑Off)
• Greets patients warmly and professionally, stating name and role, and clearly communicates each step of the care/interaction as appropriate
• Works collaboratively with colleagues and site management to ensure a positive experience and timely resolution for all patient interactions and inquiries whether in person, by phone or via electronic messaging.
• Proactively anticipates patient needs, and participates in service recovery by applying the LEARN model (Listen, Empathize, Apologize, Resolve, Notify), and escalates to leadership as appropriate.
• Shares ideas or any observed areas of opportunity, to improve patient experience and patient access, with appropriate leadership. (i.e. ways to optimize provider schedules, how to minimize delays, increase employee engagement, etc.)
• Partners with internal and external team members to support collaboration and promote a positive patient experience.
• Takes a proactive approach in ensuring that practice staff are fully versed in the Access Agreement gold standard principles.

To qualify you must have a High School Diploma or GED. Experience in medical billing, accounts receivable, insurance, or related duties;
Knowledge of CPT and ICD
10; medical billing software;
English usage, grammar and spelling; basic math; 2 years experience in a similar role. Light, accurate keyboarding skills required. Prefer that candidates type 35 words per minute (wpm) or greater on the typing assessment that will be administered prior to onboarding. Strong verbal and written communication skills, with the ability to…