Job Description

Job Description

Job Description

The Billing Specialist is responsible for billing paper and electronic claims for primary and secondary payers. Completes timely and accurate billing for designated payer class ensuring all claims are submitted on the same day of receipt. Monitors outstanding accounts and applies late charges. Receives and answers billing-related inquires and prepares daily billing activity and balancing reports.

DUTIES AND RESPONSIBILITIES:

• Performs various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers, Medicare, and Medicaid.
• Receive payment denials, investigate, and rectify the situation with either the payer or patient to include claim reconsiderations and appeals and consulting with patient and/or his or her family as needed.
• Review assigned aging reports.
• Work with office team leads to obtain insurance referrals, pre-authorizations, and verification as it relates to denied claims.
• Initiate private pay collections after insurance cancellation, denials, or other issue.
• Work with patients to develop self-pay arrangements and payment plans.
• Assist patients and their families with applying for CareCredit and other financial solutions.
• Posting insurance and patient payments to open invoices in a timely manner
• Processing electronic remits, credit card payments, and other payments
• Following up on outstanding claims
• Reconciling payments and posting them to patient accounts with the correct amount and adjustment.
• Answers questions from patients, staff, and insurance companies.
• Document payment records and issues as they occur.
• Works closely with the billing director, center managers, team leaders, and corporate medical director to ensure all processes are streamlined to minimize disruption in patient care while maximizing reimbursement.
• Other duties and responsibilities may apply as the position evolves.
• Ensure medical data is secure, accessible, and accurate for billing and reimbursement for all services.
• Maintaining a comprehensive knowledge of contemporary health record and coding practices.
• Keep current on payer requirements via research and coaching to ensure guidelines and procedures are being met for each payer.
• Maintains strictest confidentially; adheres to all HIPAA guidelines/ regulations.
• Must have a clear understanding of company policies, including the company manual, and department policies.

Requirements

KNOWLEDGE, SKILLS, AND ABILITIES:

• Exceptional Customer Experience – Understands and anticipates customer needs, takes action to meet customer’s needs. Strives to exceed customer expectations.
• Proactive- Keep others informed. Ask for help when needed, brings service challenges to supervisor.
• Drive for Results – Strives for improving the delivery of services with a commitment to continuous improvement.
• Focus on Efficiency – Utilizes technology, innovation, and process improvements to continuously improve efficiency and effectiveness.
• Teamwork- Participates as a team member and establishes strong working relationships with teammates and across the organization.
• Celebrates Change- Receptive to new ideas and responds to changes with flexibility and optimism.
• Continues Learning and Improvement- Acknowledges own strengths and development needs and works to strengthen capabilities.
• Must be well organized and detail oriented.
• Ambitious attitude.
• Heavy knowledge in denial management.
• Knowledge of insurance rules and denial codes.
• Knowledge of coding guidelines.
• Knowledge of business office procedures.
• Knowledge to apply intermediate math skills.
• Ability to solve practical problems and deal with a variety of variables.
• Skill in answering telephone in a pleasant and helpful manner.
• Ophthalmology experience preferred.
• Must possess the physical, mental, and cognitive skills needed to complete essential tasks, including abilities such as learning, remembering, focusing, categorizing, and integrating information for comprehension, problem-solving, and timely decision-making.

EDUCATION:

Associates’ degree plus a minimum of 2 – 5 years’ experience in medical billing, medical office collections, or insurance verification.

CPC/HIT certification required. COPC certified or willing to obtain COPC within 3 months of hire.

TYPICAL PHYSICAL DEMANDS:

• Sitting, Standing, Bending, Reaching, Stooping, Walking and Lifting.
• Ability to see, hear, and speak with sufficient capability to perform assigned tasks.
• Ability to use keyboard.
• Ability to use electronic medical record and scheduling software.
• The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be construed as an exhaustive list of all duties to be performed.

We are committed to a policy of non-discrimination and equal employment opportunity. All patients, employees, applicants, and other constituents of our clinical groups will be treated with respect and dignity regardless of race, national origin, gender, age, religion, disability, veteran status, marital/domestic partner status, parental status, sexual orientation, and gender identity and/or expression, other dimensions of diversity or common human decency. We value diversity in thought and culture and welcome highly skilled, capable, competent, collegial members to our team.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

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