Billing Specialist III

POSITION SUMMARY:

The Billing Specialist III is responsible for maintaining assigned payer accounts receivable, including but not limited to working to overturn denied claims, following up on other unpaid claims, researching credit balances, and correcting billing errors.  The representative will also act as a company resource for his or her assigned payers. This employee will be eligible to work from home after 6 months in the position (consideration dependent on performance, productivity and additional training needs). 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Maintains a thorough understanding of the policies and procedures of his or her assigned payer(s), reviews payer correspondence, and participates in webinars and other educational programs to keep current on these policies.
• Notifies management of payer updates that are pertinent to the practice.
• Understands up-to-date billing guidelines.
• Understands basic coding guidelines needed to support themselves in daily decision making or routing to the appropriate person for configuration.
• Adheres to all related policies and procedures and participates in improving departmental issues.
• Works on assigned accounts receivable daily, including researching claim denials and underpayments and collecting unpaid balances from third party payers. (up to and including secondary claims status, filing, denials, and working of the encounter)
• Understands the revenue cycle process, up to including Retina benefits investigations and financial assistance programs that are offered to the patient. 
• Files corrected claims or resubmits missing claims to payer(s) for processing and payment.
• Notifies supervisor of error or audit patterns or trends.
• Research payer credit balances and makes corrections and/or submits refund request when necessary.
• Answers telephone promptly and courteously, responds to patient or co-worker questions about balances or billing. Handles all emails and voice mails daily.
• Collects patient payments according to HEC guidelines as necessary.
• Understanding of payment cycle posting (insurance and personal) from all sources. This person can essentially assist in the payment posting as a backup when necessary.
• Performs all necessary job functions related to new technological implementations.
• Meets productivity goals set by supervisor. 

POSITION  REQUIREMENTS:

Minimum Qualifications: 

1. High school diploma or equivalent.
2. 3+ years of accounts receivable experience in a medical office.
3. Understanding of CPT and ICD coding and national billing guidelines.
4. Three years of insurance billing experience.
5. Three years of ophthalmic experience.

Preferred Qualifications:

1. Relevant coding and billing certifications.