A Billing Clerk prepares and checks information included on a customer bill or invoice. Assembles and itemizes information on products or services purchased, and verifies amounts including any tax owed.
The Cardiovascular Billing Representative is responsible for understanding and performing all aspects of the revenue cycle, including insurance verification, prior authorizations, charge review, claim submission, denial management, appeals, and insurance follow-up. This position ensures patients are financially cleared prior to services while maximizing reimbursement through accurate billing, timely follow-up, and compliance with payer, federal, and regulatory guidelines. The representative works collaboratively with providers, clinical staff, scheduling, and management to ensure timely and accurate reimbursement while delivering exceptional customer service.
Insurance Verification:
Verify insurance eligibility, benefits, and coverage prior to scheduled services. Confirm deductibles, copayments, coinsurance, out-of-pocket responsibilities, and referral requirements. Review medical necessity requirements and identify services requiring prior authorization. Document verification findings accurately in the electronic medical record (EMR). Communicate financial responsibility and coverage issues to patients and appropriate staff. Notify scheduling and providers of insurance concerns that may impact patient care or reimbursement.
Prior Authorizations:
Obtain prior authorizations for cardiovascular procedures, diagnostic testing, imaging, and specialty services. Submit required clinical documentation to insurance carriers in a timely manner. Track authorization requests, approvals, denials, and expiration dates. Follow up on pending authorizations to avoid delays in patient care. Communicate authorization status to providers, scheduling staff, and patients.
Medical Billing & Claims:
Review provider documentation for billing accuracy, completeness, and compliance. Submit clean electronic and paper claims within established billing timelines. Apply appropriate CPT, ICD-10-CM, HCPCS, and modifier coding based on documentation. Review claim edits and resolve billing errors prior to claim submission. Maintain compliance with Medicare, Medicaid, commercial insurance, and Workers' Compensation billing guidelines. Assist with charge corrections and claim resubmissions as needed.
Insurance Follow-Up:
Work assigned accounts receivable aging reports to ensure timely reimbursement. Research unpaid, denied, rejected, or underpaid claims and initiate corrective action. Contact insurance carriers regarding claim status, payment delays, and reimbursement discrepancies. Prepare and submit corrected claims, appeals, and supporting documentation. Identify denial trends and communicate recurring issues to management for process improvement. Document all account activity accurately within the practice management system.
Qualifications:
Minimum of 3 years of physician or medical billing experience . Cardiovascular billing experience preferred but not required. Experience with insurance verification, prior authorizations, and claims follow-up. Knowledge of Medicare and commercial insurance and the payer guidelines. Experience with NextGen Practice Management/EMR preferred. CPC certification is preferred but not required. Strong communication, organizational, and problem-solving skills. Ability to manage multiple priorities while maintaining a high level of accuracy.
Core Competencies:
Medical Billing Insurance Verification Prior Authorizations Claims Follow-Up Denial Resolution & Appeals Revenue Cycle Management Customer Service Medical Terminology Attention to Detail Time Management Problem Solving Team Collaboration HIPAA Compliance Knowledge of CPT, ICD-10-CM, and HCPCS coding principles
Physical Requirements:
Prolonged periods of sitting at a desk and working on a computer. Frequent use of hands and fingers for typing, data entry, and operating standard office equipment. Ability to communicate effectively in person and by telephone, including speaking and hearing clearly. Ability to review and interpret detailed information on computer screens and paper documents. Occasional standing, walking, bending, and reaching as needed to retrieve files or office supplies. Ability to lift and carry up to 15 pounds on an occasional basis. Ability to work in a fast-paced office environment while maintaining attention to detail and accuracy. If you're looking to contribute to a growing cardiology practice and work in a supportive team environment, apply today!
