Optical Billing Specialist

West Point Optical Group

Company: West Point Optical Group
West Point Optical Group is a Franchisee with 61 Pearle Vision franchises throughout Ohio, Indiana, Michigan, Colorado, Arizona, Pennsylvania, and Florida. The Central Billing Office supports all locations.  

JOB TITLE:                 Optical Billing Specialist / Technician

REPORTS TO:             Senior Director of Practice Administration

FLSA STATUS:           Hourly; Non-Exempt

Optical Billing Specialist

General Purpose

Billing Specialists responsibilities include managing client billing and ensuring procedures are billed according to contracts, reviewing and updating client statements as necessary, printing and mailing all paper and secondary claims, scanning documents to patient accounts, and reviewing correspondence and following up as needed. 

Main Job Tasks and Responsibilities

• Interacts with patients, family members, external healthcare related companies, law firms, co-workers and other MH employees to resolve billing issues or concerns


•  Assesses the nature of incoming calls and identifies and completes appropriate action in a prompt manner.  Activities may include:
  
  
  
  • Research specific transactions on a claim
  
  
  • Re-send patient statement
  
  
  • Re-bill a claim
  
  
  • Add or change insurance information
  
  
  • Verify eligibility on account
  
  
  • Pull an explanation of insurance benefits for payment information
  
  
  • Request adjustment on a claim
  
  
  • Send itemized statements
  
  
  
  

• Reviews incoming patient correspondence


• Understands all key processes in the CBO including activities related to billing, collections/follow-up, posting and customer service and how their actions impact the Revenue Cycle


• Organizes work/resources to accomplish objectives and meet deadlines


• Maintains compliance with federal, state and local regulations, HIPAA and the Corporate Responsibility Program


• Reports issues and trends to appropriate management personnel in CBO and works collaboratively to develop solutions


• Consistently demonstrates a positive and professional attitude at work 


• Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, customers and co-workers


• Maintains compliance with established corporate and departmental policies and procedures, quality improvement program, customer service and productivity expectations


• Maintains satisfactory attendance and punctuality record as set forth by Mercy Health policies


• Responsible for other relevant work functions, as requested


• Provides supportive assistance to patients regarding billing concerns/issues 


• Answers incoming calls from patients and returns calls, addressing patient’s questions or concerns in a professional and ethical manner

Specialized Knowledge/Skills:

• Experience with Microsoft Word and Excel preferred


• Demonstrate in-depth knowledge and experience in the following technology solutions; patient accounting systems, optical imaging, scanning and internet-based insurance websites.


• Extensive knowledge of Medicare and Medicaid regulations and other insurance guidelines preferred.


• Medical terminology, knowledge of insurance and reimbursement procedures preferred.

Experience: 

• Minimum of 1 -2 years business office experience in a healthcare environment.


• Experience in claim follow-up in a Physician practice environment preferred.


• Excellent phone etiquette and internal/external customer service skills required.


• Ability to communicate and work with payers to get claims resolved and paid accurately

Education:

• High School diploma or GED required, associate degree preferred


• Business courses such as medical terminology, accounting, finance, cash applications, typing, and word processing