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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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