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
Work Location
Hybrid, Poway, CA
Job Information
Job Type: Full-time | Expected hours: 40 per week | Pay: $23.00 - $30.00 per hour
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Job Tags
Hourly pay, Full time, Work at office, Monday to Friday, Shift work, Day shift, 1 day per week,