Billing Representative III; A​/R - Boynton , Florida

Position Summary

We have an exciting opportunity to join our team as a Billing Representative III. Under general direction the Billing Representative III performs advanced billing and financial clearance functions including claims management, complex denial resolution, insurance authorizations, precertifications, and patient cost estimates. This role provides support to staff with escalated issues and participates in training and process improvement efforts.

• Perform billing tasks assigned by management which may include data entry, claim review, charge review, accounts receivable follow‑up, 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 and 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 CBO Pathways as guide for determining actions needed to resolve unpaid or incorrectly paid claims and/or for authorizing procedures in assigned workqueue(s) using payer websites, billing system information and training within expected timeframe.
• Review reports to identify revenue opportunities, unpaid claims, delays in obtaining authorizations/financial clearance.
• Adhere to general practices and departmental guidelines on compliance issues and patient confidentiality.
• Communicate with providers, patients, coders, or other responsible persons to ensure that claims are correctly processed by third party payers.
• 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. Maintain confidentiality.
• Read and apply policies and procedures to make appropriate decisions.
• Coordinate functions and work cooperatively with others.
• Responsible for assisting other billing representatives with difficult and escalated issues.
• Assist department supervisor with special projects and staff training.
• Appeal complex denials through review of payer policies, coding, contracts, and medical records. Utilize subject matter experts as needed.
• Cross cover other areas in the office as assigned by management including Accounts Receivable/Denials, 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; 3 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…