Job Description

Position Summary

The A/R Specialist is responsible for the company's third-party medical claims processing and assisting patients and office staff with questions on insurance claims, authorizations, statements, and other billing issues. This position will prepare, submit and follow-up on medical claims for Managed Care Organization (MCO), Medicaid, Medicare, Other Federal, Private Insurance, and Workers Compensation.

**Applicants who live and plan to work from the following states will not be considered at this time: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Idaho, Montana, Maryland, Massachusetts, Michigan, Nevada, New Mexico, Oregon, New Hampshire, New Jersey, Utah, New York, Rhode Island, Washington, and Wyoming. Thank you for your interest.

Responsibilities

1. Files and processes primary and secondary third-party medical
2. Verifies all the information for claims processing is complete and
3. Contacts the appropriate person to obtain missing or unclear billing
4. Follows-up by website and/or telephone on all unpaid and denied claims to determine next course of action, which may require rebilling missing claims, denied claims or sending additional information on pending claims
5. Sends appeal letters to insurance
6. Obtains authorizations when needed.
7. Identifies and corrects charge entry/ billing
8. Provides proper documentation to insurance companies.
9. Handles insurance company questions, complaints, and/or responds to and interacts with patients concerning all aspects of billing through phone, e-mail, or regular mail in a prompt and courteous
10. Documents all actions and maintains permanent records of patient
11. Assists with answering phones, screening calls and following-up on
12. Works with management on patient billing and insurance
13. Processes refunds to patients and insurance
14. Works with outside programs (i.e., co-pay assistance) to ensure proper
15. Communicates with front office staff to attempt to collect any outstanding patient
16. Contributes to the team effort by completing other tasks and projects as needed

Qualifications

• Minimum of one (1) year Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system
• CPC, CPOC, COC certifications a plus
• Six months of previous customer service experience preferred
• Prior experience with an electronic medical record system required (EHR/EMR)
• Working knowledge of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; and strong knowledge of Federal payer regulations
• Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes
• Ability to handle sensitive and confidential information in a professional manner
• Maintains knowledge of coordination of benefits requirements and processes
• Demonstrated success working in a team environment focused on meeting organization goals and objectives is necessary
• Self-motivated with strong organizational skills and superior attention to detail
• Ability to review documents for accuracy and reasonability
• Ability to work well under pressure
• Ability to multi-task, set priorities and follow through without direct supervision
• Effectively communicate with physicians, patients, insurers, colleagues, and staff
• Intermediate computer skills including Microsoft Office; especially Word, Excel, and PowerPoint
• Knowledge of policies and procedures to accurately answer questions from internal and external customers
• Detail oriented and tolerant of frequent interruptions and distractions from patients and staff
• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external
• Exercises sound judgment in responding to inquiries; understands when to route inquiries to next level
• Team player that develops strong collaborative working relationships with internal partners and can effectively engage and ability to build consensus among cross-functional teams

Company Benefits

We offer a competitive benefits package to our employees:

• Medical
• Dental
• Vision
• 401k w/ Match
• HSA/FSA
• Telemedicine
• Generous PTO Package

We also offer the following benefits for FREE:

• Employee Discounts and Perks
• Employee Assistance Program
• Group Life/AD&D
• Short Term Disability Insurance
• Long Term Disability Insurance

EyeSouth Partners is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

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