Billing Representative III - Boynton Beach, Florida

NYU Langone Health • Boynton Beach, FL

2d

About The Position

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. The role supports staff with escalated issues and participates in training and process improvement efforts.

The representative performs assigned billing tasks, works designated queues, identifies and escalates payer, provider credentialing, and coding issues, and uses departmental workflows and resources to resolve unpaid or incorrectly paid claims and authorize procedures. The position also reviews reports for revenue opportunities and delays, communicates with providers, patients, coders, and other responsible parties, and follows operational policies, compliance guidance, regulatory requirements, and confidentiality standards.

The role assists colleagues with difficult or escalated issues, supports the supervisor with special projects and staff training, appeals complex denials, and may cross-cover accounts receivable/denials, customer service, or authorizations. It also emphasizes a consistent, collaborative patient experience, timely resolution of inquiries, proactive service recovery, and adherence to the department's CARES and LEARN service approaches and Access Agreement principles.

Requirements

• High school diploma or GED.
• Experience in medical billing, accounts receivable, insurance, or related duties.
• Knowledge of CPT and ICD-10.
• Knowledge of medical billing software, English usage, grammar and spelling, and basic math.
• Three years of experience in a similar role.
• Light, accurate keyboarding skills.
• Strong verbal and written communication skills and ability to collaborate across departments.
• Strong critical-thinking and effective-listening skills.
• Professional demeanor and positive attitude.
• Time-management skills.
• Ability to develop and maintain effective working relationships with peers, other staff, and leadership.
• Ability to communicate effectively with all levels of the organization.

Nice To Haves

• Typing speed of 35 words per minute or greater is preferred; a typing assessment will be administered prior to onboarding.

Responsibilities

• Perform assigned billing tasks, which may include data entry, claim review, charge review, accounts receivable follow-up, and related duties.
• Provide input on system edits, processes, policies, and billing procedures to help maximize revenue.
• Complete daily tasks in assigned work queues according to manager assignments.
• Identify payer, provider credentialing, and coding issues and address them with management.
• Follow trained workflows and request additional training as needed.
• Use CBO Pathways, payer websites, billing system information, and training to resolve unpaid or incorrectly paid claims and authorize procedures within expected timeframes.
• Review reports to identify revenue opportunities, unpaid claims, and delays in authorizations or financial clearance.
• Follow departmental compliance practices and guidelines for patient confidentiality.
• Communicate with providers, patients, coders, and other responsible persons to ensure claims are correctly processed by third-party payers.
• Follow operational policies and procedures and regulatory requirements.
• Participate in workgroups and meetings, attend required training, escalate issues as needed, and maintain confidentiality.
• Read and apply policies and procedures to make appropriate decisions.
• Coordinate functions and work cooperatively with others.
• Assist other billing representatives with difficult and escalated issues.
• Assist the department supervisor with special projects and staff training.
• Appeal complex denials by reviewing payer policies, coding, contracts, and medical records, and consult subject matter experts as needed.
• Cross-cover other office areas as assigned, including Accounts Receivable/Denials, Customer Service, or Authorizations.
• Provide a consistent patient and colleague experience by embodying the CARES principles: Connect, Align, Respond, Ensure, and Sign-Off.
• Greet patients professionally, state name and role, and communicate each step of the interaction as appropriate.
• Collaborate with colleagues and site management to support a positive experience and timely resolution of patient interactions and inquiries, in person, by phone, or electronically.
• Anticipate patient needs and participate in service recovery using the LEARN model: Listen, Empathize, Apologize, Resolve, Notify; escalate to leadership as appropriate.
• Share opportunities to improve patient experience and access with appropriate leadership.
• Partner with internal and external team members to promote collaboration and a positive patient experience.
• Help ensure practice staff understand the Access Agreement gold standard principles.
• Perform other related duties as assigned.

Benefits

• Comprehensive benefits and wellness package for employees and their loved ones.
• Financial security benefits.
• Generous time-off program.
• Employee resource groups for peer support.
• Holistic employee wellness program covering physical, mental, nutritional, sleep, social, financial, and preventive-care areas.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED