Company Overview:

At Community Eye Care Specialists our mission is to provide our patients with the highest level of quality care and we treat them like members of our family -- because they are. We serve the Northern PA and the Southern NY area with office locations in Warren, Dunkirk, Olean, Seneca, and Jamestown. Our mission is simple as we are helping people see!

Position Summary:

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.

Pay Range - $15.50-18.25/hr.  Commensurate with experience

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 one (1) year 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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