Job Title: Claim Readiness and Billing Specialist

SUMMARY

The Claim Readiness & Billing Specialist is responsible for resolving all assigned claim edits & claims submissions to third-party payers in a timely and efficient manner. These edits will be resolved and submitted within the clearinghouse or the practice management system in a manner determined by Insurance Billing Supervisor. They will also ensure prior day edits are accurately resolved and prepared for billing, identify and propose new claim edits and changes to current protocols, and identify root cause issues that are then communicated to RCM leaders and dealt with based upon RCM impact.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Charge review & posting of paper fee tickets as applicable.
• Resolve claim edits daily while noting account actions for a complete audit trail of billing activity.
• Ensure all prior day’s edits have been accurately resolved and the claim is ready to bill.
• Submission of assigned claims to third-party payers.
• Process clearinghouse rejections daily for assigned payers.
• Maintain applicable system and website logins and review payer correspondence or bulletins for protocol or regulatory changes.
• Maintain a complete understanding of bill edit and submission protocols within required software systems.
• Identify opportunities for new claim edits and provide recommendations to management for the implementation of identified edits.
• Identify root cause issues causing claim edits and communicate these issues to RCM leadership for upstream education via an understanding of how billing edits impact overall AR.
• Adhere to ECP confidentiality policy which includes verbal, written, computer-generated, computer accessed, filmed, and recorded information related to patients, their family and visitors, staff, physicians, clients, and is responsible for the protection of the confidentiality of data at all times.
• Work safely and follow all ECP safety requirements, reporting all incidents, near misses, and adverse events.

 

QUALIFICATIONS

• Possess strong working knowledge of CPT coding and ICD10 coding as it relates to ophthalmology medical services.
• Understand the utilization of modifiers and other coding rules to include the AMA and other coding organizations.
• Knowledge of medical terminology and consistent application of medical documentation requirements.
• Ability to follow policies and procedures for compliance, medical billing, and coding
• Ability to type and enter data with proficiency and accuracy.
• Ability to prioritize tasks and goals while remaining detail-oriented.
• Excellent customer service skills.
• Knowledge of medical terminology, healthcare coding systems, and clinics functions.
• Experience in the use of CPT and HCPCS.
• Previous Retina coding experience.
• Experience in Optometry/Ophthalmology physician practice environment.

 

EDUCATION AND/OR EXPERIENCE

• Minimum Required: HS or G.E.D.
• Minimum Required: 2 years of billing, follow-up, or related experience

 

LICENSES AND CREDENTIALS

• Minimum Required: Certified Professional Coder (CPC), Ophthalmic Coding Specialist (OCS)

SYSTEMS AND TECHNOLOGY

• Proficient in Microsoft Excel, Word, PowerPoint, Outlook.

Ability to operate essential office equipment, including multi-line phone, computer, fax machine, scanner, and photocopy machine

 

 

 

 

 

ESSENTIAL DUTIES AND RESPONSIBILITIES 

● Manages all communications relating to invoices and incoming bills and may work with Accounts Payable Specialists to balance company financial records.

● Maintain knowledge of company bookkeeping policies, audit business ledgers, organize invoices and begin the collections process for client accounts with past-due balances.

● Process and record any unique billing situations that fall outside of regular operations such as custom payment plans.

● Review unpaid claims and research reasons for delay.

● Initiate collection follow up of unpaid or denied claims with the appropriate payer.

● Research appeal and resolve claim rejections, underpayments, and denials with payers.

● Process appeals by gathering information and resubmitting claims.

● Create reports and balance sheets that document overall profits and losses.

 ● Communicate payment or denial trending that impact revenue to leadership.

● Develop and maintain positive working relationships with team members and payer representatives. ● Update client accounts based upon payment or contact information. ● Contact insurance companies to address discrepancies and ensure claims are paid.

● Review outstanding accounts and aging reports.

● Process any adjustments ad hoc.

 

QUALIFICATIONS 

● Excellent verbal, written, and interpersonal skills

 ● Knowledge of explanation of benefits (EOB’s)

● Detail-oriented with strong organizational skills EDUCATION AND/OR EXPERIENCE

● Minimum Required: HS Diploma or G.E.D.

● Minimum Required: 1+ years of experience in accounts receivable LICENSES AND CREDENTIALS

● Minimum Required: None SYSTEMS AND TECHNOLOGY

● Proficient in Microsoft Excel, Word, PowerPoint, Outlook

 

NOTE: Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time

 

Physical Requirements:

While performing the duties of this job, the employee is regularly required to talk and hear. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee must frequently lift and/or move up to 10 pounds.

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. 

If you need assistance with this application, please contact (636) 227-2600

EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Please do not contact the office directly – only resumes submitted through this website will be considered.

 

NOTE:  Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time