Medical Biller

Our Mission is to deliver best-in-class ophthalmic and optometric care.

Team members are hired to assist the organization in building a differentiated integrated eye care platform focused on superior patient care delivered through our network of optometrists and ophthalmologists. Team members are expected to a behavior of professionalism, which includes but is not limited to, acting with integrity and accountability, support our clinicians in all aspects of patient care delivery, support a culture of respect, diversity and inclusion in our organization, and enhance the patient access to primary and specialty eye care. Our vision is to create an admired healthcare company dedicated to delivering personalized eye care with outstanding patient outcomes. 

GENERAL SUMMARY:

The billing specialist is responsible for managing the financial side of patient care by preparing and submitting insurance claims to patients' insurance companies, tracking claim statuses, following up on unpaid claims, collecting patient payments, and resolving billing discrepancies, essentially acting as a liaison between the medical practice and insurance providers to ensure timely and accurate reimbursement for services rendered.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Creates and submits accurate medical claims to insurance companies using appropriate billing codes (ICD-10, CPT) based on patient medical records. 
• Verifies patient insurance eligibility and benefits prior to claim submittal to ensure accuracy. 
• Monitors the status of submitted claims, following up with insurance companies regarding claim denials or delays. 
• Records received payments from insurance companies and patients onto patient accounts. 
• Generates patient invoices for outstanding balances and contacting patients regarding payment arrangements. 
• Investigates and appeals denied claims by providing necessary documentation to insurance companies. 
• Maintains billing tracker for any pending information needed in order to ensure clean claim submission and avoid timely denials.
• Maintains accurate patient demographic information and billing records within electronic health records (EHR) systems. 
• Adheres to HIPAA regulations regarding patient confidentiality and data security. 
• Provides superior customer service to patients, team members and third party institutions regarding billing questions or concerns.

EDUCATION AND EXPERIENCE REQUIRED:

• High School diploma or equivalent, required.  
• Minimum of six (6) months experience in healthcare administration, medical billing or medical coding.

EDUCATION & EXPERIENCE PREFERRED:

• Experience in ophthalmology medical billing or medical coding

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

• N/A

LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:

• Certified Professional Biller, Certified Professional Coder and/or Certified Medical Reimbursement Specialist

CORE COMPETENCIES:

• Strong communication, including writing, speaking and active listening
• Great customer service skills, including interpersonal conversation, patience and empathy
• Good problem-solving and critical thinking skills
• In-depth knowledge of industry best practices
• Basic math, bookkeeping and accounting skills
• Organization, time management and prioritization abilities
• Ability to be discreet and maintain the security of patient or customer information
• Effective computer skills to input to use bookkeeping and account management software in a timely and efficient manner
• Understanding of industry-specific policies, such as HIPAA regulations for health care

PHYSICAL ACTIVITY OF POSITION:

• Talking. This position requires expressing or exchanging ideas through the spoken word. This position must participate in activities to convey detailed or essential verbal instructions to physicians, staff, and vendors accurately and succinctly.
• Hearing. This position is required to perceive sounds at normal speaking levels with or without correction, including the ability to receive detailed information through oral communication and make the discriminations in sound.
• Repetitive motion. This position requires substantial movements (motions) of the wrists, hands, and fingers while working on reports or the computer.
• Sedentary work. This position may need to occasionally exert up to 10 pounds of force to lift, carry, push, pull, or otherwise move objects. The job consists primarily of sedentary work and involves sitting most of the time. Walking and standing are required only occasionally.
• Visual Requirements. This position is required to have close visual acuity (with or without correction) to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; and extensive reading.
• Environmental Conditions. This position is not substantially exposed to adverse environmental conditions (such as in typical office work.)