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Insurance Billing Specialist

The Insurance Billing Specialist services as optical store assistant who helps process insurance claims for insurance companies. He/she must be willing to be familiar with insurance diagnosis codes, optical terminology and have a firm understanding of the optical field.

*Major Duties and Responsibilities*

• Assembles and maintains patient records
• Reviews patient records and interact with optometrists to ensure all relevant information has been recorded
• Gather and review medical documentation for qualifying coverage to ensure payment will be made
• Obtain, verify and maintain current insurance info to ensure proper and timely claim payment
• Review, correct and submit claims/invoices for payment Obtain Prior Authorizations as necessary by product line and payer Interpret denials/correspondence and work with insurance companies to receive payment.
• Submit reconsiderations, redeterminations and appeals when applicable
• Utilize payer resources, web portals and customer service phone lines to communicate with payers regarding timely reimbursement and denials

*Job Requirements:*

• Able to work independently and in a team atmosphere.
• Proficient in Microsoft Office, Word and Excel.
• High level of accuracy and attention to detail a must.
• Demonstrate a high level of integrity and ability to problem solve.
• Must be comfortable navigating through a variety of software programs and insurance websites.
• Understanding of Medicare, Medicaid and private insurance billing and reimbursement process.
• Maintain thorough understanding of different insurance contracts/payers we handle and keep abreast of any changes with these contracts.
• Knowledge of HIPPA guidelines, confidentiality and record keeping.
• Customer service driven with the ability to communicate effectively and maintain professional and ethical standards of conduct.

• Prior experience in a fast paced medical billing environment is beneficial. Credentialing knowledge experience is a plus.

*Education and Experience*

• High school or equivalent.

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