What are the responsibilities and job description for the Insurance & Billing - Denials Specialist position at Whitewater Eye Centers LLC?
About the Position:
The Denials Specialist will report to the I & B Manager and will focus on promoting Whitewater Eye Centers financial health and following the billing cycle for all locations to maximize cash flow. The Denials Specialist will work closely with insurance payers to go over account receivables, work denials, billing, payment posting, understands policy and guideline changes, recoupment payments, correspondence letters and going over patient balances.
*This position will primarily focus on insurance denials*
Required Education and Experience:
1. Three years of medical billing & coding experience; at least two years processing medical denials.
2. Experience in EHR billing system; NexTech preferred
3. Additional certifications related to medical billing and coding preferred.
Essential Skills and Abilities:
1. Strong organizational skills and attention to detail.
2. Computer literacy, including knowledge of software programs utilized in the practice.
3. Bookkeeping skills with a working knowledge of medical billing software.
4. Knowledge of insurance rules and regulations, including Medicare/Medicaid
5. Knowledge of CPT and ICD-10 coding.
6. Good communication skills.
7. Ability to work as a team member.
8. Management of multiple projects simultaneously.
9. Respectful treatment of patients and co-workers.
Key Responsibilities:
1. Prioritize and review denied insurance claims and resolve billing specified to unpaid claims
2. Communicate with management to resolve billing disputes and escalations
3. Review code change requests to determine accurate coding and/or advise coding or billing changes to ensure appropriate reimbursement
4. Contact carriers and patients to maximize reimbursement on accounts to be worked
5. Serve as a point of contact for billing problem solving
6. Respond to correspondence inquiries by phone, mail for resolution
7. Respond to inquiries from staff members regarding patient charges, coding and eligibility
8. Maintain high level of patient confidentiality to ensure compliance with HIPAA regulations
9. Responsible for managing daily billing functions for assigned insurance payer
10. Responsible for submitting accurate coding and billing procedures to obtain appropriate reimbursement for commercial, government, third party payers, and other network entities
11. Post payments and balance unapplied payments from carrier remits, self-pay
Physical Activity of Position:
• Talking. This position requires expressing or exchanging ideas through the spoken word. This position must participate in activities to convey detailed or essential verbal instructions to physicians, staff, and patients accurately and succinctly.
• Hearing. This position requires the ability to perceive sounds at normal speaking levels with or without correction, including the ability to receive detailed information through oral communication and discriminate between sounds.
• Repetitive motion. This position requires substantial movements (motions) of the wrists, hands, and fingers while working on reports or on the computer.
• Sedentary work. This position may need to occasionally exert up to 10 pounds of force to lift, carry, push, pull, or otherwise move objects. The job consists primarily of sedentary work and mainly involves sitting. Walking and standing are required only occasionally.
• Visual Requirements. This position requires close visual acuity (with or without correction) to prepare and analyze data and figures, transcribe, view a computer terminal, and read extensively.
• Environmental Conditions. This position is not substantially exposed to adverse environmental conditions (such as typical office work).
Equal Opportunity Employer:
Whitewater Eye Centers is an equal employment opportunity employer and complies with all applicable laws relating to discrimination against qualified applicants or employees in hiring or in any decision affecting job status, pay, or any other terms and conditions of employment based on race, color, creed, religion, national origin, sex, marital status, familial status, disability, genetic information, sexual orientation, age, or other applicable protected classes.