Billing Specialist

We are seeking a dedicated and reliable Medical Billing Specialist/Authorization Specialist to join our ophthalmology practice in Wexford, PA. The ideal candidate will have prior experience with prior authorizations, patient collections (specifically for elective surgeries), and claims submissions. This position is responsible for ensuring accurate and timely billing processes while maintaining excellent communication with patients and insurance providers.

Job Title: Billing Specialist/Authorization Specialist
Location: Wexford, PA
Schedule: Full-Time, Monday to Friday, 8:00 AM - 4:00 PM
Pay: $18 - $20 per hour

Key Responsibilities:

• Prior Authorizations: Submitting and managing prior authorizations for elective surgeries, ensuring timely approval from insurance providers.
• Patient Collections: Contacting patients before surgery to collect payment for lenses (ranging from $1,500 to $5,000). Although patients are aware of the need for payment, your role will involve reminding them and facilitating the collection process.
• Submitting EOBs (Explanation of Benefits): Ensure proper submission of EOBs for completed procedures.
• Medical Records Submission: Sending medical records to insurance companies that have denied claims due to insufficient documentation.
• Claims Submission and Processing: Submitting claims to insurance providers and following up to resolve any issues with claim denials or rejections.
• Billing Data Management: Gathering necessary billing information from practice management (PM) systems, electronic medical records (EMR) systems, and online payer portals.
• Maintain Records: Ensure that all billing records, reports, and files are complete, accurate, and properly stored.
• Confidentiality and Compliance: Maintain strict confidentiality of patient information and comply with all company and regulatory policies and procedures.

Skills, Abilities, and Knowledge:

• Proficient in electronic billing systems
• Strong computer skills, including proficiency in computer programs, spreadsheets, and applications
• Excellent communication and customer service skills
• Knowledge of medical insurance processes and terminology
• Previous medical office experience is preferred

Preferred Qualifications:

• 2-3 years of prior experience in a similar billing role, particularly with prior authorizations and patient collections (experience with elective surgery collections is a plus)
• Experience with claims submission is a plus but not required
• Strong work tenure and consistency in previous positions

How to Apply:
Interested candidates are encouraged to submit their resumes and highlight relevant experience related to the key responsibilities listed. If applicable, we will give you an introductory phone call with further details. We look forward to hearing from you!

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.