Claims Readiness and Billing Specialist
Claims Readiness and Billing Specialist
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Salary Not Disclosed
1 Vacancy
Job Description
EyeCare Partners is the nations leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision advance eye care and improve lives. Based in St. Louis Missouri over 650 ECPaffiliated practice locations provide care in 18 states and 80 markets providing services that span the eye care continuum. For more information visit.
Job Title: Claim Readiness and Billing Specialist
Job Summary
The Claim Readiness & Billing Specialist I is responsible for resolving all assigned claim edits & claims submissions to thirdparty 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 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.
Duties and Responsibilities
Resolve claim edits daily while noting account actions for a complete audit trail of billing activity.
Ensure all prior days edits have been accurately resolved and the claim is ready to bill.
Submission of assigned claims to thirdparty 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 computergenerated 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.
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:
HS Diploma
Experience Requirements
2 years of billing followup 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 multiline phone computer fax machine scanner and photocopy machine.
Professional in appearance and actions
Logical and Critical thinking skills to problem solve
Customerfocused 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 onsite team members work takes place in a normal office/clinical environment. Travel to other locations may be necessary to fulfill the essential duties and responsibilities of the job. Thus those needing to travel for work must have access to dependable transportation and their driving record must meet company liability carrier standards.
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
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 right to assign or reassign duties and responsibilities to this job at any time
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)
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.
Required Experience:
Unclear Seniority
Employment Type
Full Time
