Claims Readiness and Billing Specialist II

Job Title: Claim Readiness and Billing Specialist II

SUMMARY

The Claim Readiness & Billing Specialist is responsible for resolving all assigned claim edits & claims submissions to third-party payers in a timely and efficient manner. These edits will be resolved and submitted within the clearinghouse or the practice management system in a manner determined by the Insurance Billing Supervisor. They will also ensure prior day edits are accurately resolved and prepared for billing, identify and propose new claim edits and changes to current protocols, and identify root cause issues that are then communicated to RCM leaders and dealt with based upon RCM impact. The Level II Claim Readiness and Billing Specialist also performs charge entry and requires coding knowledge.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Charge review & posting of fee tickets as applicable.

• Resolve claim edits daily while noting account actions for a complete audit trail of billing activity.

• Ensure all prior day’s edits have been accurately resolved, and the claim is ready to bill.

• Submission of assigned claims to third-party payers, where applicable.

• Process clearinghouse rejections daily for assigned payers.

• Maintain applicable system and website logins and review payer correspondence or bulletins for protocol or regulatory changes.

• Maintain a complete understanding of bill editing and submission protocols within required software systems.

• Identify opportunities for new claim edits and provide recommendations to management for the implementation of identified edits.

• Identify root cause issues causing claim edits and communicate these issues to RCM leadership for upstream education via an understanding of how billing edits impact overall AR.

• Adhere to ECP confidentiality policy which includes verbal, written, computer-generated, computer accessed, filmed, and recorded information related to patients, their family and visitors, staff, physicians, clients, and is responsible for the protection of the confidentiality of data at all times.

• Work safely and follow all ECP safety requirements, reporting all incidents, near misses, and adverse events. 

• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.

• Performs other duties that may be necessary or in the best interest of the organization.

 

EDUCATION AND/OR EXPERIENCE

• Minimum Required: HS or G.E.D.

  • Minimum Required: 2 years of billing, follow-up, or related experience

  • Experience in Optometry/Ophthalmology physician practice environment. 

  • Experience in the use of CPT and HCPCS

   

Knowledge, Skills and Abilities Requirements

• Possess strong working knowledge of CPT coding and ICD10 coding as it relates to ophthalmology medical services.

• Understand the utilization of modifiers and other coding rules to include the AMA and other coding organizations.

• Knowledge of medical terminology and consistent application of medical documentation requirements.

• Ability to follow policies and procedures for compliance, medical billing, and coding

• Ability to type and enter data with proficiency and accuracy.

• Knowledge of medical terminology, healthcare coding systems, and clinics functions.

• Ability to operate essential office equipment, including multi-line phone, computer, fax machine, scanner, and photocopy machine. 

• Professional in appearance and actions

• Logical and Critical thinking skills to problem solve

• Customer-focused with excellent written, listening and verbal communication skills

• Enjoys learning new technologies and systems 

• Detail oriented, professional attitude, reliable, prioritizing tasks and goals

• Exhibits a positive attitude and is flexible in accepting work assignments and priorities

• Meets attendance and tardiness expectations

• Management and organizational skills to support the leadership of this function

• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations

• Interpersonal skills to support customer service, functional, and teammate support need

           Able to communicate effectively in English, both verbally and in writing

• Ability for basic to intermediate problem solving, including mathematics

• Intermediate to Advanced computer operation

            Proficiency with Microsoft Excel, Word, PowerPoint and Outlook

• Travel to other site locations may be necessary. Thus, those needing to travel for work must have access to dependable transportation, and driving record must meet company liability carrier standards

• Specialty knowledge of systems relating to job function

• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

 

Location/Work Environment: 

For remote team members, HIPAA compliant home office environment. Ability to work in a remote environment while performing required duties and remaining patient focused. Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives. 

Exposure: Works in a normal office environment during normal business hours. May be exposed to blood or bodily fluids. May also be exposed to various cleaning supplies.

Equipment: The equipment typically used in this position is a computer, fax, copier, printer, scanner and telephone. Must have good working knowledge of Microsoft applications. Other equipment may be used as needed. Personal Protective Equipment (PPE) follows standard precautions using personal protective equipment.

 

Physical Requirements:

While performing the duties of this job, the employee is regularly required to talk and hear. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee must frequently lift and/or move up to 10 pounds.

Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. 

If you need assistance with this application, please contact (636) 227-2600

EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Please do not contact the office directly – only resumes submitted through this website will be considered.

 

NOTE:  Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time