The Billing Specialist II is responsible for the timely collection of insurance and patient accounts receivable for the practice. Duties for this position would include the successful completion of all activities pertaining to the billing and collection of patient and insurance accounts.

MINIMUM QUALIFICATIONS

Education and Experience:

• High school diploma or GED required
• Experience in medical billing required
• Experience in ophthalmic billing, patient collections and coding preferred
• CPC Certification and Ophthalmic certification in coding required

ESSENTIAL SKILLS AND ABILITIES

• Proficient computer skills
• Ability to problem solve
• Detail oriented
• Gain a complete understanding of Medicare, Medicaid and commercial insurance plans
• Familiarity with ICD-9/10 and CPT Codes
• Familiarity with ophthalmic terminology and diseases that affect the eye
• Excellent communication skills, proper grammar and writing capability
• Team-oriented
• Self-directed, highly motivated, able to multi-task and work under pressure in a fast-paced environment
• Exceptional interpersonal skills
• Possess a caring, patient and friendly attitude
• Familiarity with all forms associated with the patient’s medical record
• Must have the ability to perform all functions the Accounts Receivable/Billing Department

PHYSICAL REQUIREMENTS:

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.

• The majority of the time on-the-job is spent walking and sitting
• At times the job may require weight to be lifted up to 50 pounds
• The job requires the following types of vision: close, distance, peripheral and depth perception
• Typical noise level for the work environment of this job is moderate (i.e. business office with computers and printers, light traffic)
• Must be able to communicate clearly in person and over the telephone
• Hearing must be adequate to perform job duties in person and over the telephone
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

DUTIES AND RESPONSIBILITIES

• Possess a complete hands-on working knowledge of applicable billing & collections software
• Review the aging collection report as appropriate to ensure the timely collection of receivables
• Provide billing and collections training education and development for the staff as needed
• Review, submit and monitor collection agency accounts
• Monitor changes in insurance plans and policies. Inform management of such changes on an immediate basis
• On an ongoing basis, monitor insurance websites for updates and policy changes
• Answer the telephone and responds to all billing questions in a timely and efficient manner
• Provide additional information as requested by insurance companies on claims that have been denied within 48 hours of denial
• Track surgical volumes to ensure timely payment of surgical claims
• Enter notes on patient ledger regarding information sent or received from insurance companies and from patients
• Coordinates weekly transmittal of patient statements with outside vendors
• Attaches documentation as needed to paper claims and prepares for mailing
• Review patient balances on the aging receivable report and take corrective action as needed to improve insurance and patient collections
• Prepare aging reports for all insurance plans
• Prepare aging reports for patient balances
• Identify unpaid insurance claims that are more than 30 days old on a continuous basis:
• Address claims that fall within timely filing deadlines first
• Address highest dollar amount claims second
• Address largest carriers third
• Work the remainder of the report from beginning to end
• Identify unpaid patient accounts that are more than 30 days old on a continuous basis:
• Address highest dollar amount claims first
• Work the remainder of the report from beginning to end
• Establish patient payment plans as necessary
• Ensure collection of accounts receivable are within the MGMA standards for ophthalmology
• Accept verbal and written credit card information with the highest level of confidentiality
• Maintains proper standards of productivity as defined by management
• Professional and Personal Development/Goals and Objectives
• Exhibit professional demeanor with a positive attitude at all times when representing the practice
• Maintain certification, where applicable, while continuing to improve skills.
• Must attend all in-service and webinar training as directed by the Director of Managed Care
• Set goals and objectives for professional growth. Review and revise goals on an ongoing basis
• Provide input on how to improve customer service, decrease costs and increase revenue for the practice
• Customer Service
• Support the practice core values and mission statement to develop, enhance and promote quality customer service through team effort.
• Exhibit flexibility, sensitivity and respect while maintaining an effective working relationship with all team members
• Maintain practice confidentiality, follow HIPAA guidelines and the rules and regulations of the practice as documented in the practice employee manual
• Perform other duties as assigned

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.

• The majority of the time on-the-job is spent walking and sitting
• At times the job may require weight to be lifted up to 50 pounds
• The job requires the following types of vision: close, distance, peripheral and depth perception
• Typical noise level for the work environment of this job is moderate (i.e. business office with computers and printers, light traffic)
• Must be able to communicate clearly in person and over the telephone
• Hearing must be adequate to perform job duties in person and over the telephone
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function