About this role
Company Overview
At Vitreo Retinal Associates, we’re more than a leading retina specialty practice—we’re a team dedicated to preserving and restoring vision for our patients. Specializing in advanced care for retinal conditions like macular degeneration, diabetic retinopathy, and retinal detachment, we combine cutting-edge technology with compassionate, personalized treatment.
Position Summary
This positin is based full time onsite at the Gainesville office.
The A/R Specialist is responsible for the company’s third-party medical claims processing and assisting patients and office staff with questions on insurance claims, authorizations, statements, and other billing issues. This position will prepare, submit and follow-up on medical claims for Managed Care Organization (MCO), Medicaid, Medicare, Other Federal, Private Insurance, and Workers Compensation.
Responsibilities
- Files and processes primary and secondary third-party medical
- Verifies all the information for claims processing is complete and
- Contacts the appropriate person to obtain missing or unclear billing
- Follows-up by website and/or telephone on all unpaid and denied claims to determine next course of action, which may require rebilling missing claims, denied claims or sending additional information on pending claims
- Sends appeal letters to insurance
- Obtains authorizations when needed.
- Identifies and corrects charge entry/ billing
- Provides proper documentation to insurance companies.
- Handles insurance company questions, complaints, and/or responds to and interacts with patients concerning all aspects of billing through phone, e-mail, or regular mail in a prompt and courteous
- Documents all actions and maintains permanent records of patient
- Assists with answering phones, screening calls and following-up on
- Works with management on patient billing and insurance
- Processes refunds to patients and insurance
- Works with outside programs (i.e., co-pay assistance) to ensure proper
- Communicates with front office staff to attempt to collect any outstanding patient
- Contributes to the team effort by completing other tasks and projects as needed
Qualifications
- Minimum of two (2) years Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system
- CPC, CPOC, COC certifications a plus
- Six months of previous customer service experience preferred
- Prior experience with an electronic medical record system required (EHR/EMR)
- Working knowledge of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; and strong knowledge of Federal payer regulations
- Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes
- Ability to handle sensitive and confidential information in a professional manner
- Maintains knowledge of coordination of benefits requirements and processes
- Demonstrated success working in a team environment focused on meeting organization goals and objectives is necessary
- Self-motivated with strong organizational skills and superior attention to detail
- Ability to review documents for accuracy and reasonability
- Ability to work well under pressure
- Ability to multi-task, set priorities and follow through without direct supervision
- Effectively communicate with physicians, patients, insurers, colleagues, and staff
- Intermediate computer skills including Microsoft Office; especially Word, Excel, and PowerPoint
- Knowledge of policies and procedures to accurately answer questions from internal and external customers
- Detail oriented and tolerant of frequent interruptions and distractions from patients and staff
- Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external
- Exercises sound judgment in responding to inquiries; understands when to route inquiries to next level
- Team player that develops strong collaborative working relationships with internal partners and can effectively engage and ability to build consensus among cross-functional teams
Company Benefits
We offer a competitive benefits package to our employees:
- Medical
- Dental
- Vision
- 401k w/ Match
- HSA/FSA
- Telemedicine
- Generous PTO Package
We also offer the following benefits for FREE:
- Employee Discounts and Perks
- Employee Assistance Program
- Group Life/AD&D
- Short Term Disability Insurance
- Long Term Disability Insurance
EyeSouth Partners is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
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