[Hiring] A/R Specialist @EyeSouth Partners

Role Description

The A/R Specialist is responsible for the company’s third-party medical claims processing and assisting patients and office staff with questions on insurance claims, authorizations, statements, and other billing issues. This position will prepare, submit and follow-up on medical claims for Managed Care Organization (MCO), Medicaid, Medicare, Other Federal, Private Insurance, and Workers Compensation.

• Files and processes primary and secondary third-party medical claims.
• Verifies all the information for claims processing is complete.
• Contacts the appropriate person to obtain missing or unclear billing information.
• Follows-up by website and/or telephone on all unpaid and denied claims to determine next course of action, which may require rebilling missing claims, denied claims or sending additional information on pending claims.
• Sends appeal letters to insurance.
• Obtains authorizations when needed.
• Identifies and corrects charge entry/billing errors.
• Provides proper documentation to insurance companies.
• Handles insurance company questions, complaints, and/or responds to and interacts with patients concerning all aspects of billing through phone, e-mail, or regular mail in a prompt and courteous manner.
• Documents all actions and maintains permanent records of patient interactions.
• Assists with answering phones, screening calls and following-up on inquiries.
• Works with management on patient billing and insurance issues.
• Processes refunds to patients and insurance.
• Works with outside programs (i.e., co-pay assistance) to ensure proper processing.
• Communicates with front office staff to attempt to collect any outstanding patient balances.
• Contributes to the team effort by completing other tasks and projects as needed.

Qualifications

• Minimum of two (2) years Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system.
• CPC, CPOC, COC certifications a plus.
• Six months of previous customer service experience preferred.
• Prior experience with an electronic medical record system required (EHR/EMR).
• Working knowledge of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; and strong knowledge of Federal payer regulations.
• Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
• Ability to handle sensitive and confidential information in a professional manner.
• Maintains knowledge of coordination of benefits requirements and processes.
• Demonstrated success working in a team environment focused on meeting organization goals and objectives.
• Self-motivated with strong organizational skills and superior attention to detail.
• Ability to review documents for accuracy and reasonability.
• Ability to work well under pressure.
• Ability to multi-task, set priorities and follow through without direct supervision.
• Effectively communicate with physicians, patients, insurers, colleagues, and staff.
• Intermediate computer skills including Microsoft Office; especially Word, Excel, and PowerPoint.
• Knowledge of policies and procedures to accurately answer questions from internal and external customers.
• Detail oriented and tolerant of frequent interruptions and distractions from patients and staff.
• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external.
• Exercises sound judgment in responding to inquiries; understands when to route inquiries to next level.
• Team player that develops strong collaborative working relationships with internal partners and can effectively engage and build consensus among cross-functional teams.

Benefits

• Medical
• Dental
• Vision
• 401k w/ Match
• HSA/FSA
• Telemedicine
• Generous PTO Package
• Employee Discounts and Perks (FREE)
• Employee Assistance Program (FREE)
• Group Life/AD&D (FREE)
• Short Term Disability Insurance (FREE)
• Long Term Disability Insurance (FREE)