Medical Billing and Insurance Representative

Wheaton Eye Clinic•Wheaton, IL

5d•Onsite

About The Position

The Billing and Insurance Representative is responsible for some or all aspects of the Wheaton Eye Clinic’s medical claims and billing process. The representative reviews claims to ensure billing requirements are met, follows up on concerns, determines and applies adjustments, responds to inquiries, and updates accounts as needed. This is not a remote role.

Requirements

High school diploma or equivalent.
1–2 years of experience in billing and reimbursement for commercial insurance, Medicare, and Medicaid.
Excellent verbal and written communication skills.
Working knowledge of CPT, ICD-10, and HCPCS code sets, as well as CCI edits.
Understanding of basic medical terminology and anatomy.
Ability to understand remittance advice, EOBs, and payer correspondence, and research denial reasons.
Ability to maintain positive relationships with patients, staff, and insurance carriers.
Strong working knowledge of Microsoft Office, including Excel, Word, and Outlook.

Nice To Haves

Insurance and Billing Certificate.
CPC, CPB, or AHIMA certifications.
Optum Encoder Pro.

Responsibilities

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