Ophthalmic Billing Coordinator

Position: Billing Coordinator with advancement to Billing Specialist

Department: Billing Office

Reports To: Revenue Cycle Specialist and Practice Administrator

Job Description:
This individual is responsible for preparing and filing all insurance claims (paper and electronic claims transmission), obtaining prior authorizations for surgeries, as well as reviewing and following-up on all incorrect payment amounts or denials; posting all incoming insurance payments, balancing the business office daily business activities, closing out each day’s receipts for the deposit; complete all patient/insurance follow-up and collections on past due accounts; and make necessary write-offs and refunds according to the financial policy.

Personal Skills:
This individual must be a professional, have a positive attitude, be a team player, create efficient work patterns through organization, pay special attention to detail, possess strong customer service/ communication skills with patients, doctors, managers and co-workers, computer literate, multi task oriented and possess values and beliefs that are in accordance with the practice’s core values.

Professional Skills:
Degrees or certifications are required. One must attend ophthalmic classes and become certified in ophthalmic coding to keep up with changes in our field within 24 months of hire. We want individuals with a good attitude and that are willing and able to work together to make our company successful.

Manage Patient Accounts and Collection Process:

• Run patient statements once a week
• Work Patient Responsibility Report and segregate based on collection process.
• Statements, Past due statements, Final notices, Threshold Balance and indicate reason for balance, Collections Balance and indicate reason for balance, Payment plans and review to ensure that plan is current, otherwise patient is reworked into billing cycle
• Apply collection recovery payments from Komyatte Law office
• Run Collections Accounts Report weekly. Work report for collections balances and reasons for balances and submit report to Komyatte Law Office
• Work small balance write offs at the time insurance payments are posted.
• Process NSF checks
• Identify low payer, slow payers and delinquent payers to Practice Administrator and Office Manager as they occur
• Utilize fee schedule to determine correct payments
• Auto posting Medicare, Anthem, BCBS of IL, and ERAs
• Process insurance payments
• Understand contract payment/reimbursement guidelines to make sure we are maximizing reimbursement
• Understand coding guidelines to maximize reimbursement-including modifiers that should be used and how they affect payment
• Adjustments as needed
• Insurance company entry and editing
• Understand medical and vision plans in order to maximize reimbursement
• Understand when to execute a waiver for insurance benefit limitations
• Understand the key components of the Medicare/Medicaid programs as it relates to Ophthalmology and Optometry
• Understand the key components of our most common commercial carriers as it relates to Ophthalmology and Optometry
• Transmit insurance claims daily
• Identify and correct any denied or rejected claims while running claims processing daily
• Understand when to bill a New Patient exam or consult
• Understand when to use 92 vs. 99 codes on insurance claims
• Apply modifiers when appropriate
• Understand insurance payment/coding guidelines
• Coding and billing of all surgical services
• Coding and billing of all hospital consultations
• Coding and billing of all office services such as examinations, procedures, lasers, diagnostic tests, and optical
• Verify the necessity for pre-certifications for surgeries, office procedures and diagnostic tests
• Maintain standards for documentation by staff and doctors for insurance carriers
• Coordinate CPT and ICD-10 codes to comply with insurance company’s protocol to maximize reimbursement
• Proficiently use CPT and ICD-10 reference books.
• Surgeries
• Consults
• Maintain and proficiently understand the LCDs for the Medicare contractor and other insurance policies.
• Maintain the Medical Coding Manual and the How to Manual in the Patient Accounts Folder.
• Understand the parameters needed to run the Insurance Receivable by Carrier Report as well as interpret the Insurance Receivables by Carrier Report for claims stuck in the system and claims on hold
• Work Aging Report in accordance with the Insurance Companies Claims Payment worksheet
• Follow-up with insurance companies on any incorrect insurance payments
• Understand when to use correcting entries/adjustments and apply them accordingly
• Utilize and understand the Office Monthly Analysis worksheet
• Process all patient refunds
• Process all insurance refunds
• Process all replacement refund checks that either the patient or insurance has not been processed
• Inform appropriate person of practice management system errors as they occur
• Complete Practice Management computer training based on relevant classes
• OCS Certification in Ophthalmology

Pay: $19.00 - $25.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $19 - $25