Description

COME WATCH US GROW!

Looking to challenge your skills in the fast-paced continually evolving field of Ophthalmology?

At Florida Eye Specialists, a Sight360 company, we believe sight is our most important sense. It is a priceless gift that goes far beyond how you see the world. Sight is how we move through life, enjoy its wonders and form the memories that define us. That is why we are dedicated to care for our patient’s sight every day.

Requirements

Summary Objective: The Insurance Billing Specialist is responsible for collecting insurance claim information from patients and entering this information in the systems of record, posting insurance and patient information, submitting claims to appropriate parties, following up with insurance carriers on unpaid or rejected claims and answering patient inquiries on account status changes.

Essential Functions and Responsibilities:

• Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Ensures claim information is complete and accurate.
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper CMS-1500 form.
• Answer patient questions on patient responsible portions, copays, deductibles, write-off’s, etc. Resolves patient complaints or explains why certain services are not covered.
• Follows up with insurance company on unpaid or rejected claims. Resolves issue and re-submits claims.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal.
• Prepares patient statements for charges not covered by insurance. Ensures statements are mailed on a regular basis.
• May work with patients to establish payment plan for past due accounts in accordance with provider policies.
• Provides necessary information to collection agencies for delinquent or past due accounts.
• Posts insurance and patient payments using medical claim billing software.
• May perform “soft” collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.
• For patients with coverage by more than one insurer, prepares and submits secondary claims upon processing by primary insurer.
• Follows HIPAA guidelines in handling patient information.
• May periodically create insurance or patient aging reports using the medical practice billing software. These reports are used to identify unpaid insurance claims or patient accounts.
• Understands managed care authorizations and limits to coverage such as the number of visits. This is encountered often when billing for specialties.
• May have to verify patient benefits eligibility and coverage.
• Ability to look up ICD 9 diagnosis and CPT treatment codes from online service or using traditional coding references.

Supervisory Responsibility:

• Position reports to Revenue Cycle Manager
• No Direct Reports

Working Conditions and Environmental/Physical Demands:

• Sedentary work that primarily involves sitting/standing.
• Moving about to accomplish tasks or moving from one worksite to another.
• Light work that includes moving objects up to 20 pounds.
• Communicating with others to exchange information.
• Repeating motions that may include the wrists, hands and/or fingers.
• Operating motor vehicle.
• No adverse environmental conditions expected.

Position/Type/ Expected Hours of Work:

• This is a full-time position and core hours of work and days are Monday through Friday 8:00 a.m. to 5:00 p.m.
• Potential for evening and weekend hours as required.

Travel: No Travel is required

Qualifications:

• Minimum of 2 years of medical billing experience
• Demonstrated knowledge of medical terminology
• Medicaid, Medicare, and other third-party payor reimbursement guidelines and requirements
• Working knowledge of medical, accounts receivable, collections, rejects, denials, appeals, and research billing guidelines and policies
• Experience working with confidential medical information
• Experience in computer programs such as EMRs, Word, Excel

Skills and Abilities:

• Ability to navigate various websites and carrier portals
• Highly organized with developed time management skills
• Excellent customer service and telephone etiquette
• Excellent verbal and written communication skills
• Strong research and problem-solving skills; attentive to details
• Ability to operate a computer and general office machines
• Must be self-directed, able to work independently, as well as work in a team-oriented and fast paced environment