JOB TITLE: Insurance & Billing Coordinator
This is an Insurance Department representative position responsible for filing insurance claims, managing patient accounts and answering inquires on account status and charges from ophthalmology patients. Piedmont Eye Center insurance department representatives are responsible for collecting and entering claim information, posting insurance and patient payments and following up on unpaid and rejected claims. Also responsible for documenting all customer interactions in the appropriate computer system. This is an intermediate-level position and these representatives work out of our insurance department in Lynchburg, VA. This is a full-time position with working hours of 8:00am-5pm. Representative reports to the Office Manager.
We hire individuals who have excellent verbal and written communication skills, organizational skills, and the ability to handle multiple tasks.
* Enters information necessary for insurance claims such as patient insurance ID, diagnosis and treatment codes and modifiers and provider information. Insures that claim information is concise, complete, and accurate.
* Submits insurance claims to clearinghouses or individual insurance companies electronically or via paper CMS-1500 form.
* Answers patient questions on patient responsible portions, copays, deductibles, write-offs, etc. Resolves patient complaints or explains why certain services are not covered.
* Follows up with insurance companies on unpaid or rejected claims. Resolves issues and re-submits claims.
* Prepares appeal letters to insurance carriers when not in agreement with claim denial. Collects necessary information to accompany appeal.
* Prepares patient statements for charges not covered by insurance. Insures that statements are mailed on a regular basis.
* Follows up on past due patient balances and provides necessary information to collection agencies for delinquent accounts.
* May perform “soft” collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.
* Posts insurance and patient payments using medical claim billing software.
* Prepares and submits secondary claims upon processing by primary insurer.
* Understands managed care authorizations and limits to coverage such as number of visits.
* Verifies patient benefits eligibility and coverage.
* Meets outlined Piedmont Eye Center benchmarks and/or quality indicators as monitored through audits or recordings. Supports organizational changes. Demonstrates flexibility in providing coverage and/or availability for the insurance department via scheduling adjustments for unexpected absences, events, or work volume variances.
* Performs opening balancing procedures.
* Processes Patient and Insurance Carrier refunds.
* Other duties and special projects that are assigned by management.
Service Delivery Expectations:
* Patient centered care focused.
* Meets Piedmont Eye Center service standards in all categories.
* Follows HIPAA guidelines in handling patient information.
* Meets the expectations of our internal and external customers in providing excellent service.
* Demonstrates positive customer relationship skills with all telephone encounters.
* Seeks and supports changes in departmental processes and services. Suggests improvements and participates in organized efforts to improve service levels.
* Willingly performs other duties or tasks as assigned and handles multiple tasks effectively and efficiently.
* Promotes sense of pride in insurance department and positive interpersonal relations among all team members.
* Exhibits commitment to effective problem solving techniques when issues arise.
* Continuously acts to maintain a safe, clean, healthy, and fun work environment consistent with Piedmont Eye Center’s professional patient/caller service, vision, values, and endeavors.
* Arrives at workstation on time, ready to work, and demonstrates minimal absenteeism.
* Demonstrates effective problem solving skills
* Computer skills that include a combination of experience in a Windows Operating System, e-mail, and data entry experience.
* Ability to look up ICD-10 diagnosis and CPT treatment codes from online service or traditional coding references.
* Prior experience with Medical billing software
* At least 3-5 years of insurance billing experience in a previous job.
* Prior experience in an Ophthalmology practice
* Prior experience with medical office PM software.
* High school or equivalent
* insurance billing: 3-5 years