Full Cycle - Medical Billing Specialist

Job Description

Job Description

Medical Billing & Revenue Cycle Specialist (Interventional Cardiology)

Location: Stuart, FL (On-Site)
Employment Type: Full-Time

Position Overview

A high-volume Interventional Cardiology practice is seeking an experienced Medical Billing & Revenue Cycle Specialist to support all aspects of the end-to-end revenue cycle (RCM). Reporting to the Practice Administrator, this role is responsible for charge capture, coding validation, claims submission, denial management, A/R follow-up, and reimbursement optimization across professional services including office, hospital, and telehealth encounters.

The ideal candidate will demonstrate advanced knowledge of cardiology billing guidelines, payer policies, and regulatory compliance, with hands-on experience in EMR/PM systems such as Athenahealth (AthenaOne) or similar platforms.

Key Responsibilities

• Perform accurate charge entry and reconciliation for CPT, HCPCS, and ICD-10-CM diagnosis coding related to interventional cardiology procedures and services
• Ensure timely and compliant electronic claims submission (EDI) in accordance with Medicare, Medicaid, and commercial payer guidelines
• Proactively manage Accounts Receivable (A/R) including insurance aging, follow-ups, and resolution of outstanding claims
• Analyze and resolve claim denials, rejections, and underpayments, including preparation of appeals with supporting clinical documentation
• Monitor payer trends and identify root causes impacting reimbursement, providing actionable feedback to leadership
• Maintain daily workflow in Athena hold buckets/work queues, ensuring timely resolution of edits and exceptions
• Verify patient eligibility and benefits, including copayments, deductibles, coinsurance, and prior authorization requirements
• Generate and review patient statements; manage patient collections and payment posting accuracy
• Coordinate with clearinghouses and payers to ensure clean claim rates and reduced days in A/R
• Process refunds, credit balances, and overpayment reconciliations in compliance with payer and regulatory guidelines
• Support internal audits and compliance initiatives, ensuring adherence to HIPAA, CMS regulations, and OIG guidelines
• Assist with referrals and prior authorizations, particularly for cardiac procedures and diagnostics
• Communicate effectively with patients, providers, and insurance carriers to resolve billing inquiries
• Stay current with updates in coding, billing regulations, and payer policies impacting cardiology services

Qualifications

• Minimum 3+ years of experience in medical billing and revenue cycle management, preferably within cardiology or a specialty practice
• Strong working knowledge of:
  • ICD-10-CM, CPT, and HCPCS coding systems
  • Medicare and commercial payer reimbursement methodologies
  • EOB/ERA interpretation and denial codes (CARC/RARC)
• Experience with EMR/Practice Management systems (Athenahealth preferred; Epic, eClinicalWorks, NextGen also acceptable)
• Familiarity with clearinghouses (e.g., Change Healthcare, Availity)
• Understanding of HIPAA compliance, CMS billing regulations, and payer-specific guidelines

Preferred Certifications

• Certified Professional Biller (CPB®) – AAPC
• Certified Coding Specialist (CCS®) – AHIMA
• Certified Professional Coder (CPC®) – AAPC (preferred for cardiology coding exposure)

Compensation & Benefits

• Salary: Commensurate with experience
• Comprehensive benefits package including:
  • 401(k)
  • Health, Dental, and Vision Insurance
  • Paid Time Off (PTO)

Schedule

• Monday – Friday
• On-site position (Stuart, FL daily)