Optical Biller

Description

The primary role of the Optical Biller is to perform prompt submission and follow up of optical claims in addition to timely ordering of materials (eyeglasses and contact lenses).

ESSENTIAL FUNCTIONS:

To perform this job successfully, an individual must be able to perform each essential function satisfactorily with or without accommodation. The requirements listed below are representative, but not all inclusive, of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions. 

1. Verifies diagnosis, insurance and claim details prior to posting and submitting claims for payment
2. Order materials (eyeglasses and contact lenses) and bill claims in vision websites daily
3. Research, initiate follow up and resolve all unpaid or underpaid claims with appropriate insurance payor
4. Submits reconsiderations, redeterminations and appeals when applicable
5. Resubmits corrected claims to various optical and medical insurance companies either electronically or by paper
6. Reviews insurance payment for accuracy and compliance with contract discount
7. Meet with Manager/Supervisor to discuss and resolve reimbursement and/or billing issues 
8. Other duties as assigned by management

Requirements

REQUIRED: At least 5 or more years of related work experience. Operational management knowledge of medical offices. Equivalent to high school diploma or general education degree (GED). 

DESIRABLE: Associates or Bachelor’s Degree. Knowledge of WORD, EXCEL, POWERPOINT and Care Cloud applications. Experience leading a team, mentoring and coaching subordinates. Experience in the Ophthalmic industry.  

CERTIFICATES/LICENSES/REGISTRATIONS:

• AHIMA or AAPC Certified Coding Specialists or Certified Professional Coder (preferred)

KNOWLEDGE/SKILLS/ABILITIES/TALENTS:

• Ability to multitask and manage time effectively
• Ability to effectively communicate, collaborate, and problem solve across multiple functional areas and departments
• Ability to accurately manage detailed information
• Outstanding problem-solving and organizational abilities
• Ability to work effectively in a team environment
• Working knowledge of CPT and ICD-10 code systems (preferred)
• Knowledge of optometry billing (preferred)

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. 

• This is primarily an office classification. Temperature conditions are controlled with limited direct exposure to hazardous physical substances. The noise level in the work environment is usually low to moderate.  
• While performing the duties of this job, the employee is regularly required to sit, stand, walk, handle, or feel, reach with hands and arms, see, talk and hear. The employee will frequently lift and/or carry reports, records and other materials that typically weigh less than 20 pounds. The employee is occasionally required to stoop, kneel, bend, or crouch. 
• Finger dexterity is needed to access, enter, and retrieve data using a computer keyboard, calculator, and other standard office equipment.

All of the information contained herein reflect general details as necessary to describe the principal functions of this classification, the level of knowledge and skill typically required and the scope of responsibility, but should not be considered an all-inclusive listing of work requirements. Management reserves the rights to add, modify, change, or rescind the duties and/or work assignments of all positions, without advanced notice, and to make reasonable accommodations so that qualified employees can perform the essential functions of the job.

Notwithstanding any of the foregoing described job responsibilities, employee shall not engage in activities that constitute the practice of ophthalmology as prohibited under applicable law. Employee shall neither exercise control over nor interfere with the clinician-patient relationship. Clinicians shall have sole responsibility for all professional services provided to patients.