Claims and Eligibility Specialist

Job Description

Job Description

About the Company

The next generation of independent cardiology is being built here. CardioOne is a physician-led, technology-driven cardiology platform built to empower independent practices to compete, and win, in a rapidly evolving healthcare landscape.

Our mission is to provide cardiologists with the tools, infrastructure, and expertise they need to thrive while maintaining full clinical independence. We believe the best care is delivered by physicians who are empowered - not constrained - by the systems around them.

We combine a deep bench of healthcare operators with purpose-built technology and AI-enabled solutions across operations, revenue cycle, imaging, and practice development. From real estate and advanced imaging to clinical workflows and data infrastructure, CardioOne delivers a fully integrated platform designed to drive growth, efficiency, and superior patient outcomes.

Backed by WindRose Health Investors and leading healthcare executives, CardioOne is building one of the most sophisticated and scalable cardiology MSOs in the country - designed to reimagine what is possible for independent cardiology.

About the Job

Cardiac Associates of North Jersey, is seeking motivated individuals to join our team as a Claims and Eligibility Specialist. You will be responsible for verifying patient insurance coverage, obtaining benefit and authorization information, and ensuring accurate eligibility for medical services prior to treatment. This role works closely with patients, insurance companies, and healthcare providers to minimize claim denials and ensure accurate billing and reimbursement.You will report directly to the Practice Manager.

Schedule: Monday through Friday, no weekends, 7:30AM to 4:30 PM.

Compensation: $20 to $23.50 per hour, dependent on experience.

Benefits: Medical, Dental, Vision, Paid Time Off (1 week PTO, 5 days sick time)

What you’ll do:

• Verify patient insurance eligibility and benefits for scheduled procedures and office visits

• Obtain and document pre-authorizations and referrals when required

• Review patient demographic and insurance information for accuracy

• Contact insurance companies to confirm coverage, deductibles, co-pays, co-insurance, and out-of-pocket responsibilities

• Contact patients regarding outstanding balances and arrange payment collection when necessary

• Communicate financial responsibility and estimated costs to patients professionally and compassionately

• Contact patients regarding outstanding balances and arrange payment collection when necessary

• Update electronic medical records (EMR) and billing systems with verified insurance information

• Resolve insurance discrepancies and coverage issues prior to services being rendered

• Work closely with front desk staff, billing department, and clinical teams to ensure smooth patient processing

• Maintain compliance with HIPAA and all insurance regulations

• Assist with claim follow-up and denial prevention as needed

• Other duties as assigned

What you’ll need:

• High school diploma or equivalent required; and/or billing certification preferred

• Minimum of 1–2 years of experience in medical insurance verification, medical billing, or healthcare administration

• Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans

• Familiarity with CPT, ICD-10, and authorization processes preferred

• Strong computer skills and experience with EMR/practice management systems

• Excellent communication, organizational, and customer service skills

• Ability to multitask and work in a fast-paced healthcare environment

• Knowledge and use of EHRs (Athena experience is a plus!)

• Attention to detail and accuracy

• Strong problem-solving abilities

• Ability to maintain confidentiality

• Professional phone etiquette

• Time management and organizational skills

• Team-oriented mindset with the ability to work independently