The Billing and Insurance Representative is responsible for any or all aspects of the medical claims and billing process for the Wheaton Eye Clinic. The Billing and Insurance will review claims to ensure billing requirements have been met and provide follow-up on any concerns, determine and apply adjustments, answer inquiries and update accounts as necessary.

Responsibilities:

• Identify and resolve inquiries from patients, staff and insurance companies
• Determine insurance eligibility for patients and assist with referral issues
• Prepare and review claims for submission to clearinghouse following all insurance carrier guidelines
• File electronic Medicaid claims in accordance with state Medicaid rules
• Perform Surgery billing and apply modifiers per Correct Coding Initiative
• Prioritize high dollar denied claims and appeals in aging report
• Maintain and review aging reports and take action on overdue accounts
• Apply Medicare LCD Articles as appropriate to claims and appeals
• Maintain confidentiality and strictly follow HIPAA and regulatory guidelines
• Follow Wheaton Eye Clinic customer service and Medicaid guidelines

Education:

• High School Diploma or equivalent
• Insurance and Billing Certificate helpful
• CPC, CPB, AHIMA certifications a plus
• Optum Encoder Pro
• Strong working knowledge of Microsoft Office ( Excel, Word, Outlook)

Qualifications/Requirements

• 1-2 years experience in billing and reimbursement for commercial insurance, Medicare and Medicaid.
• Excellent verbal and written communication skills.
• Knowledge base in CPT, ICD-10, and HCPCS code sets as well as CCI edits.
• Understanding of basic medical terminology and anatomy.
• Ability to understand remittance advice, EOB’s and payor correspondence and research denial reasons.
• Ability to maintain positive relationships with patients, staff and insurance carriers.

Competitive salary and benefit package, generous 401K program.