Over the years, Ophthalmology LTD’s name provides the highest quality of comprehensive medical and surgical eye care. Highly trained ophthalmologists, as well as experienced optometrists, combine their considerable expertise to give each and every patient the best possible care. Ophthalmology LTD delivers treatment for cataracts, glaucoma, and diabetic eye disease, as well as cornea transplants, oculoplastic surgery, retina surgery, and vitreoretinal surgery in Sioux Falls.
We are looking to add a Medical Billing/Insurance Specialist to our team. This person will be responsible for medical billing, coding, charge posting, insurance claims filing and follow-up, payment processing and reimbursement, and patient account management which includes answering patient and clinic staff inquiries, performing all aspects of collection activity with insurance payers and patients, and resolution of billing issues.

Job duties include:

• Entering patient demographics and insurance coverage, verify eligibility and benefits.
• Assist with counseling patients in understanding medical benefits for services provided, self-pay obligations, and set up payment plans and agreements according to Ophthalmology Ltd. Patient Financial Policies. Electronic and paper claims submission, scrubbing, and monitoring claims and reports via clearinghouse software. Claims follow-up to include identifying errors and performing modification as necessary for resubmission due to claim denials and/or inadequate reimbursement.
• Perform charge entry of clinic and surgery charges, to include monitoring and reviewing chart documentation, and assigning and appropriately linking CPT/ICD codes for claim accuracy and monitoring posting reports for accuracy.
• Payment posting (auto-post, ERA/EFT, and manual) to include contractual adjustments and monitoring of overpayments and refunds.
• Patient Account Managements to include in clinic or phone inquiries and counsel patients on out-of-pocket estimates, self-pay balances, and payment plans.
• Daily and monthly reconciliation, balancing; perform internal audits of medical record documentation on a routine basis; communicate and educate doctors and staff as appropriate.

Education and Training requirements:

• High School Diploma.
• Prefer post-secondary education.
• Ideal candidate will possess knowledge of CPT and ICD coding in medical practice and has a thorough understanding of medical terminology and anatomy. Certification is encouraged: Certified Professional Coder, CPC or Ophthalmic Coding Specialist, OCS.
• Minimum 2 years medical billing experience in physician office setting with knowledge of various medical payer practices and insurance laws/guidelines (Medicare, Medicaid, Work Comp, VA, and other third-party payers). 2 years computer experience with more than two practice management A/R and Electronic Medical Record Systems.

• Entering patient demographics and insurance coverage, verify eligibility and benefits.
• Assist with counseling patients in understanding medical benefits for services provided, self-pay obligations, and set up payment plans and agreements according to Ophthalmology Ltd. Patient Financial Policies. Electronic and paper claims submission, scrubbing, and monitoring claims and reports via clearinghouse software. Claims follow-up to include identifying errors and performing modification as necessary for resubmission due to claim denials and/or inadequate reimbursement.
• Perform charge entry of clinic and surgery charges, to include monitoring and reviewing chart documentation, and assigning and appropriately linking CPT/ICD codes for claim accuracy and monitoring posting reports for accuracy.
• Payment posting (auto-post, ERA/EFT, and manual) to include contractual adjustments and monitoring of overpayments and refunds.
• Patient Account Managements to include in clinic or phone inquiries and counsel patients on out-of-pocket estimates, self-pay balances, and payment plans.
• Daily and monthly reconciliation, balancing; perform internal audits of medical record documentation on a routine basis; communicate and educate doctors and staff as appropriate