Job Description

Billing Specialist

The Billing Specialist will play a vital role in the financial operations of our ophthalmology practice, ensuring that claims are processed efficiently and patient billing inquiries are handled with care. The role encompasses a range of tasks within the billing department, including medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, reimbursement management, and authorization management.

Reports to: Revenue Cycle Manager

Key Responsibilities

• Work on accounts receivable (A/R), process rejected claims, and perform necessary follow-up to ensure successful claim processing.
• Follow up on claims using various systems, including Nextech EHR, TriZetto clearinghouse, and others.
• Prepare and submit clean claims to insurance companies electronically or by paper.
• Correct and resubmit claims to third-party payers when needed.
• Mail appropriate patient contact letters to resolve outstanding claims.

Billing Operations

• Maintain contact with other departments to obtain and analyze patient information for accurate billing documentation.
• Respond to patient inquiries and billing concerns via phone, email, and messaging portals.
• Perform follow-up calls and written correspondence to patients and payers as needed.
• Prepare, review, and send patient statements as necessary.

Authorization Management

• Obtain and verify insurance authorizations and pre-certifications for procedures and services.
• Ensure all necessary authorizations are secured prior to patient appointments and procedures.
• Track authorization expirations and follow up on renewals as needed.
• Communicate with patients and insurance companies to resolve authorization issues or delays.

Customer Service & Compliance

• Identify and resolve patient billing complaints in a timely manner.
• Adhere to policies regarding safety, confidentiality, and HIPAA guidelines.
• Establish and maintain effective working relationships with office staff and doctors, ensuring a collaborative work environment.

Qualifications and Requirements

• Minimum of 2+ years of experience in ophthalmology billing.
• Knowledge of medical terminology specific to ophthalmology.
• Proficiency in CPT, HCPCS, and ICD codes related to ophthalmology.
• High school diploma required; an associate degree is preferred.

Skills

• Ability to work independently with minimal supervision.
• Strong organizational and time management skills.
• Detail-oriented with the ability to manage multiple tasks and meet deadlines.
• Strong communication skills, with the ability to effectively interact with patients and office staff.
• Resourceful, result-driven, and a team player.

Work Environment

• Hybrid position with the ability to be on-site for meetings, training, or other work-related functions.
• The position may also require on-site job responsibilities that require being in the office once a week.
• Monday through Friday, 8:00 AM to 5:00 PM.

Compensation

Compensation Range: $23.00-$30.00 per hour

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule

• 8-hour shift
• Day shift
• Monday to Friday

Experience

• ICD-10: 2 years (Required)

Ability to Commute

• Poway, CA (Required)

Work Location

Hybrid, Poway, CA

Job Information

Job Type: Full-time | Expected hours: 40 per week | Pay: $23.00 - $30.00 per hour

Job Tags

Similar Jobs