Tier Ii Insurance Billing Specialist

West Point Optical is looking for a resourceful team player with versatility and adaptability that can make a difference on our growing Billing Team.

You’ll have the opportunity to work with an organization whose brands and partners are making a difference in people’s lives every day in an environment where hard work and achievement are recognized and rewarded.

This position requires a seasoned insurance professional and an effective communicator. We are looking for a visible, hands-on worker who always retains a professional demeanor, always, and can make thoughtful decisions.

This is an amazing opportunity to be a part of a thriving company. You’ll have the opportunity to support the implementation of policies, procedures, and systems. The person in this role needs to be motivated and have a desire to advance their career through learning from some of the industry's best, while showcasing your Insurance Billing and customer service skills.

POSITION ACTIVITIES INCLUDE BUT NOT LIMITED TO:

• Adhere to policies, procedures and systems for proper coding and quality assurance.
• Responsible for the assigned day-to-day functions of an Tier IIInsurance Billing Specialist which consists of:
  • Answer provider inquiries/calls daily via phone or email
  • Support clinics for any insurance related questions, including benefit interpretation
  • Obtaining authorizations when needed
  • Reconcile claim runs, create electronic claim files, and resolve errors
  • Resolve claims editing issues and interact with third party clearinghouse or the claims scrubber vendor to produce clean claims
  • Identify recurring billing errors and trends and report them to supervisor when necessary
  • Conduct research / analyze coding errors, document billing issues / trends, and assist with problem solving and solutions
  • Proactively collect active outstanding A/R from regulatory payers
  • Contact insurance payers by either phone or online inquiry regarding unpaid claims
  • Review remaining balances on accounts after insurances have paid to determine appropriate next action
  • Review denials by regulatory payers for entire claims or line items to determine if additional follow up is needed or assistance from other internal departments and forward to them as needed
  • Ensures efficient processing of denials and appeals
  • Processes incoming payments both through ERA and manually when needed
  • Maintain patient demographic information and data collection systems.
  • Implement and adhere to policies, procedures and systems for proper coding and quality assurance.
  • Train and educate new and existing employees on billing procedures and systems
  • Participates in educational activities and attends monthly staff meetings.
  • Report on all claims received vs. submitted, both weekly and monthly to Director of RCM, CFO and CEO
  • Monthly A/R reporting for all payor plans
  • Participate in CBO special projects as assigned
  • Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
  • Assists in development and communication of SOPs for key areas to improve accuracy and understanding of processes.
  • Performs miscellaneous job-related duties as assigned.

EDUCATION AND WORK EXPERIENCE REQUIREMENTS:

• 3+ years’ optometry billing experience (both medical and vision) required
• 2+ years’ experience with benefit verifications and insurance eligibility checks
• 1+ years’ experience with requesting and obtaining authorizations with commercial and Medicaid insurance carriers
• Knowledge of vision payer websites and manual claims filing
• Experience in Revolution EHR and Acuity Logic preferred
• Knowledge of Trizetto/Gateway clearinghouse
• Ability to read and interprate an explanation of benefits from an insurance company
• Proficient in using various computer programs and must have extensive MS Office Suite experience (Excel, Word, PowerPoint, Outlook)
• General knowledge of medical terminology, ICD10, CPT and modifiers
• Ability to think logically in following procedures and instructions
• Ability to self-direct confidently in the absence of defined/detailed instructions
• Ability to multi-task and work in a fast-paced team oriented environment
• Highly organized and detail oriented
• An effective communicator with strong oral, written, and persuasive skills and capability to deal with people at all levels in the organization.