Optometry Claims Coordinator 2

The Ohio State University•Columbus, OH

2d•$18 - $23•Onsite

About The Position

The Claims Coordinator is responsible for accurate and timely claims processing, effective management of patient accounts, ensuring accurate data collection within the OSU College of Optometry.

Requirements

Minimum of 1 year experience in a health care setting
Ability to collaborate and communicate effectively at all organizational levels
Proficiency with computers and related software, including Microsoft Office
Excellent communication skills

Nice To Haves

2 years of experience in an optometry practice
Knowledge of vision and medical insurance plans
Experience with ICD-10 and CPT codes
Electronic claim submission knowledge
Experience with government and commercial medical and vision insurances such as VSP, UHC, Anthem, Aetna, Bureau of Workers Compensation, Medicare, Medicaid, Medical HMO plans, etc.
Certified Medical coder/biller

Responsibilities

Process and submit routine vision and medical vision insurance claims (e.g., Aetna, Medical Mutual, VSP) through practice management software via batch submission to the clearinghouse, manual entry into payer portals, or hard copy claims.
Submit prior authorization requests via provider portal upon receiving necessary documentation from clinical staff or providers.
Review Electronic Health Records (EHR) to verify correct coding ICD-10 and CPT, accurate posting of services/materials, and provider sign-off before finalizing and submitting claims.
Pull claim status information from provider portals, document payment and denial details on the patient's ledger, and make necessary corrections for timely claim resubmission and reprocessing.
Utilize and analyze insurance receivable reports to ensure accuracy across all patient accounts with pending insurance responsibility.
Review patient payments, and insurance payments via check, and credit card payments.
Posting, reconciling, and completing online payment deposit.
Review patient statements for accuracy and coordinate the mailing process.
Communicate clearly with patients and staff regarding account balances, explaining complex financial concepts such as copayments, co-insurance, deductibles, and maximum out-of-pocket expenses.
Assist patient inquiring about their account balance, answer insurance inquiries about upcoming services/materials. Taking patient payment information over the phone.
Accept and apply patient payments accurately to account balances, providing receipts via USPS, secure email or secure fax.
Initiate the initial steps for setting up customer numbers for patient accounts that require referral to collections.
Serve as a knowledgeable resource for newer or less experienced staff members on insurance procedures and common questions.
Proactively verify patient insurance eligibility, coverage, and benefits using specialized provider portals (e.g., Eyefinity, Clearwave, and Availity).
Independently resolve routine insurance verification issues and works with clinic staff to gather complete and accurate information when portal data is insufficient.
Manually enter complete and accurate insurance details, including effective dates, member information, copayments, and co-insurance, into the practice management software (Compulink).
Create and manage patient alerts in Compulink to notify staff, Interns, and Attending providers of benefit utilization status, coverage limitations, or non-covered services prior to the appointment.
Accurately update patient demographic and financial screens to reflect coverage changes (e.g., updating benefit expiration dates, changing the financial plan to Self-Pay).
Identify patterns of incomplete/inaccurate front desk data collection and initiate communication with management to support staff training and resource provision.