Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.

Job Duties

• Work accounts from a Queue Summary
• Responsible for collection and resolution of outstanding insurance claims
• Communicate effectively while accurately and efficiently handling high claim volume
• Must have Medicare / Medicaid billing experience
• Must have relative and current experience with commercial and all other payers billing and denials
• Research payments and denials on payer websites
• Research patient accounts for adjudication and to answer any concerns
• Submit medical records upon request, for payment of insurance claims (including colored photos)
• Send written appeals to insurance companies
• Mail secondary insurance claims
• Make additional adjustments on accounts to reflect the Explanation of Benefits
• Process patient and insurance refunds as necessary
• AdvantX experience a plus.

Competencies

• Serving Others
• Integrity
• Respect
• Leadership
• Accountability
• Action Oriented
• Team Oriented
• Professionalism
• Continual Learning
• Informing

Supervisory Experience

This position has no supervisory responsibilities.

Work Environment

This is a clerical job in a healthcare clinical setting. The Insurance Collections Specialist will primarily work in an office setting but may be required to walk to other areas of the clinic and may be exposed to contagious illnesses due to patient interactions.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is occasionally required to stand, walk; sit; use hands to finger, handle, or feel objects, tools of controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk of hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Position Type and Expected Hours of Work

This is a full-time position working primarily daytime hours Monday through Friday; however, some evening and weekend work may be necessary on occasion.

Required Education and Experience

High School Diploma or equivalent required.

Customer service experience and basic computer skills required, preferably in a windows environment with electronic medical records software.

Preferred Education and Experience

Medicare and Medicaid claims processing knowledge

Medical terminology or other previous medical office experience desirable

Knowledge of Ophthalmic terminology

Pre-certification experience

Continuing education

Additional Eligibility Qualifications

None for this position

AAP/EEO Statement

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

Other Duties

Please note that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.