Optical/Optometry Billing Specialist

Job Title: Medical Billing Specialist 1

Job Family: Patient Services

Department: Billing

Reports to: Business Office Manager

Classification: Non-Exempt Status: Full Time

Date Updated: May 2023

Our Mission

We pursue excellence in the delivery of professional, compassionate, and complete eye care.

Our Values

• Empathy | Seek to understand others’ feelings and perspectives.
• Extend Grace | Offer kindness and forgiveness.
• Desire to Help People in Need | Strong sense of social responsibility.
• Desire to Work | Perform your job regularly, consistently, and to the best of your abilities.
• Invest in Yourself | Never stop learning.

Position Summary

A successful Medical Billing Specialist (MBS) is responsible for actions that support and safeguard Fogg Remington EyeCare (FRE) Standard of Patient Care. As an MBS, you will juggle multi-tasks simultaneously and regularly complete ad hoc projects. The workday goes by quickly, and no two days are exactly alike. The MBS should be committed to the Company’s strong learning culture and creating a positive patient experience. An MBS is responsible for managing the billing process, ensuring that claims are processed accurately and in a timely manner. The MBS will prepare and submit claims to insurance companies and other third-party payers.

Essential Functions, Duties, and Responsibilities

Level 1 (Job Grade: 23)

• Enter Explanation of Benefit or Payment information from external sources into Practice Management System.
• Review and update patient demographics in Practice Management System.
• Interact with patients regarding outstanding balances to minimize patient collections.
• Identify recurring issues in billing process. Resolve and/or elevate as required.
• Follow procedures to produce statements for patients.
• Review pre billing reports for conformance with billing requirements and make changes as required.
• Process and export claim information and deliver electronically or physically to the appropriate insurance company.

All Levels

• Cross-train in relevant/related functions and roles as necessary, and assist/train other staff in related functions as needed.
• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency required.
• Maintain confidentiality by safeguarding ePHI and demonstrating HIPAA compliance to our patients.

• Ensure that HIPAA privacy policies are clearly understood and followed.
• Present a positive view of FRE to the community.
• Protect company assets.
• Support all co-workers and treat them with dignity and respect.
• Support the team to reach common goals.
• Be able to think and act quickly and efficiently in emergencies.
• May be scheduled to work at different locations as necessary, reporting to the location at beginning of the day.
• May drive on company business.
• Must have valid California driver’s license (required).
• Comply with all FRE policies and procedures, including but not limited to workplace safety, reporting work-related injuries, Infection Control, and preventing potential safety risks for staff, clients, and others.
• Punctual and regular attendance is an essential responsibility of each employee at FRE. Employees are expected to report to work as scheduled, on time, and prepared to start working. Employees are expected to remain at work for their entire work schedule. Late arrival, early departure, or other absences from scheduled hours are disruptive and must be avoided.
• Other duties as assigned. Please note that this job description is not designated to cover or contain a comprehensive listing of activities, duties, or responsibilities required for the employee. Duties, responsibilities, and activities may change at any time, with or without notice.

Education and Experience

Education

• Required: Possession of a high school diploma or GED.
• Preferred: Ophthalmic Coding Specialist Certification (OCS) and/or completion of a Medical Assistant or comparable program.

Experience

• Although previous experience as a Medical Billing Specialist is ideal, healthcare, hospitality, and retail experience are also assets.

Knowledge, Skills, and Abilities

• Good interpersonal skills and the ability to communicate effectively with different audiences.
• Intermediate to advanced phone skills; able to effectively relate via the telephone and in-person to serve the needs of Clinic patients/clients/visitors in an efficient and productive manner.
• Fluent in medical terminology used and referenced in the billing of services.
• Strong written and verbal communication.
• Ability to gracefully assist unhappy customers.
• Ability to interact and work effectively with co-workers, clients, guests, volunteers, and others.
• Well-spoken and polished demeanor.
• Cultural sensitivity and demonstrated ability to work with diverse people groups.
• Attention to detail requires a high level of accuracy and attention.
• Time management and organizational skills: prioritizing tasks, meeting deadlines, and staying organized.
• Problem-solving skills: Analyzing complex problems, developing creative solutions, and making sound decisions.
• Proficiency with Microsoft 365 (Microsoft Word/Excel/Outlook).

Work Activities, Styles, and Requirements

FRE Standards of Patient Care:

• Respect: Treat all patients with respect and dignity.
• Communication: Communicate clearly and effectively with patients and their families.
• Safety: Ensure the safety of all patients and staff.
• Quality: Provide quality care and services to all patients.
• Privacy: Respect the privacy of all patients and their families.
• Accessibility: Ensure all patients can access the care and services they need.

Empathy: Allows you to relate to teammates, patients, and customers to understand their needs and concerns better. Empathy will help you to be more understanding and compassionate when dealing with difficult situations and resolving conflicts.

Extend Grace: Ability to put yourself in the patient’s shoes to try and understand their situation, which allows you to show compassion and understanding, making the patient feel more comfortable and at ease.

Desire to help people in need: Exhibit a strong sense of social responsibility and willingness to take action and make decisions to positively impact others in our community. Display compassion to make a difference in people’s lives by going the extra mile to ensure those in need receive quality care.

Wants to work: Possess a strong desire to work hard and complete tasks promptly. Show your commitment to excellence by doing what is necessary to complete the job. Contributing to achieving team goals that value collaboration, accountability, and mutual support.

Invest in yourself: Take the time and effort to develop your skills and knowledge. Be open to learning new things and take on challenges that will help you grow professionally. Stay up-to-date on the latest trends and technologies in our field.

Benefit of the doubt: Be open-minded and consider all sides of an issue before deciding how to proceed. Be understanding and compassionate when dealing with difficult situations. Create a positive work environment and foster better relationships with your teammates and patients.

Environmental Conditions

• Indoors in a typical office environment approximately ninety-five percent (95%) of the time.
• Frequent computer use at the workstation for up to two hours.
• Frequently work at a fast pace with unscheduled interruptions.
• May occasionally move (walk or drive) from one work location to another.

Physical Demands

• Use one or two hands to grasp, move, handle, control, feel, and assemble objects, tools, or controls.
• Use fingers to grasp, move, or assemble very small objects.
• Ability to walk, sit, stand, stoop, crouch, and climb stairs.
• Ability to move and lift up to 10 pounds.
• See the differences between colors, shades, and brightness.
• Visual Acuity (Far/Near).
• Regular and Consistent Attendance.

Changes: This job description will be updated if duties and responsibilities change significantly. Job functions are subject to modification based on business necessity.

ADA/FEHA: Fogg Remington EyeCare will make reasonable accommodations in compliance with the Americans with Disabilities Act of 1990 and California’s Fair Employment and Housing Act.

EEO: Fogg Remington EyeCare is an equal opportunity employer. All aspects of employment, including the decision to hire, promote, discipline, or discharge, will be based on merit, competence, performance, and business needs. We celebrate diversity and are committed to creating an inclusive environment for all employees.