Medical Billing and Insurance Representative

Wheaton Eye Clinic LTD•Wheaton, IL

5d•Onsite

About The Position

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. THIS IS NOT A REMOTE ROLE.

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.
High School Diploma or equivalent
Strong working knowledge of Microsoft Office ( Excel, Word, Outlook)

Nice To Haves

Insurance and Billing Certificate helpful
CPC, CPB, AHIMA certifications a plus
Optum Encoder Pro

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