Insurance Billing Specialist
The Insurance Billing Specialist services as optical store assistant who helps process insurance claims for insurance companies. He/she must be willing to be familiar with insurance diagnosis codes, optical terminology and have a firm understanding of the optical field.
*Major Duties and Responsibilities*
- Assembles and maintains patient records
- Reviews patient records and interact with optometrists to ensure all relevant information has been recorded
- Gather and review medical documentation for qualifying coverage to ensure payment will be made
- Obtain, verify and maintain current insurance info to ensure proper and timely claim payment
- Review, correct and submit claims/invoices for payment Obtain Prior Authorizations as necessary by product line and payer Interpret denials/correspondence and work with insurance companies to receive payment.
- Submit reconsiderations, redeterminations and appeals when applicable
- Utilize payer resources, web portals and customer service phone lines to communicate with payers regarding timely reimbursement and denials
- Able to work independently and in a team atmosphere.
- Proficient in Microsoft Office, Word and Excel.
- High level of accuracy and attention to detail a must.
- Demonstrate a high level of integrity and ability to problem solve.
- Must be comfortable navigating through a variety of software programs and insurance websites.
- Understanding of Medicare, Medicaid and private insurance billing and reimbursement process.
- Maintain thorough understanding of different insurance contracts/payers we handle and keep abreast of any changes with these contracts.
- Knowledge of HIPPA guidelines, confidentiality and record keeping.
- Customer service driven with the ability to communicate effectively and maintain professional and ethical standards of conduct.
Prior experience in a fast paced medical billing environment is beneficial. Credentialing knowledge experience is a plus.
*Education and Experience*
- High school or equivalent.