Billing Specialist III

The Billing Specialist III supports the vision and mission of The Cardiac and Vascular Institute by performing advanced billing and accounts receivable functions. This senior-level role is responsible for complex account resolution, denial management, payment accuracy, and process improvement initiatives. The Billing Specialist III serves as a subject matter expert, provides guidance and training to junior billing staff, and collaborates with internal departments and payers to optimize revenue integrity, reduce uncompensated care, and ensure compliance with payer and regulatory requirements.

• Serve as the primary owner for researching and resolving unapplied payments, unidentified funds, and credit balances.
• Perform root-cause analysis related to unapplied cash, including posting errors, missing or incorrect charges, payer variances, and workflow gaps.
• Perform advanced billing and payment posting functions, ensuring accuracy and compliance with payer requirements.
• Research, analyze, and resolve complex billing discrepancies, underpayments, denials, and claim rejections.
• Interpret payer remittance advice and explanations of benefits (EOBs) to determine appropriate follow-up actions.
• Initiate, prepare, and follow up on insurance reconsiderations and appeals to maximize reimbursement.
• Identify denial trends and root causes; elevate findings and recommend corrective actions to prevent future denials.
• Evaluate patient financial responsibility and assist in identifying appropriate payment solutions when needed.
• Ensure accounts are accurately updated to a billable and collectible status in a timely manner.
• Support optimization of electronic claim submission by correcting errors identified in payer reports.
• Assist with accurate and timely write-offs of uncollectible accounts in accordance with departmental policies.
• Maintain strict confidentiality and comply with HIPAA and all applicable regulations.
• Perform other duties and responsibilities as assigned.

• Advanced knowledge of medical billing, insurance accounts receivable, and payer reimbursement methodologies.
• Strong working knowledge of payer-specific requirements, policies, LCDs, and NCDs.
• Demonstrated ability to analyze data, identify trends, and recommend process improvements.
• Exceptional attention to detail and accuracy.
• Ability to work independently while also functioning effectively as part of a team.
• Strong organizational, time management, and multitasking skills in a deadline-driven environment.
• Proficiency with billing systems, EHRs, and Microsoft Office applications.
• Effective verbal and written communication skills when interacting with patients, payers, and leadership.
• Ability to exercise sound judgment and elevate issues appropriately.
• Willingness to adapt to evolving workflows, technologies, and payer regulations.

• High School Diploma or equivalent (GED).
• Minimum of 5+ years of progressive experience in medical billing and/or insurance accounts receivable.

• Cardiology or cardiovascular healthcare experience.
• Prior experience handling advanced denials, appeals, and complex payer issues.

All your information will be kept confidential according to EEO guidelines.