Eye Care Medical Billing & Insurance Specialist

ADP, Inc.; Wheaton (IL); On-site; USD 28,000 - 32,000; Full time

Job summary

Wheaton Eye Clinic seeks a Medical Billing and Insurance Representative for a full-time role in Wheaton, IL. Responsibilities include handling medical claims, reviewing eligibility, and ensuring billings meet insurer guidelines.

Requirements include 1–2 years billing experience, high school diploma, and knowledge of CPT/ICD-10/HCPCS. Certification in CPC/CPB/AHIMA and Optum Encoder Pro are a plus. This is a non-remote position with competitive pay.

Qualifications

• 1-2 years experience in billing and reimbursement for commercial insurance, Medicare and Medicaid.
• Excellent verbal and written communication skills.
• Knowledge base in CPT, ICD-10, and HCPCS code sets as well as CCI edits.
• Ability to understand remittance advice, EOBs and payor correspondence and research denial reasons.
• Maintain confidentiality and HIPAA compliance.

Responsibilities

• Identify and resolve inquiries from patients, staff and insurance companies
• Determine insurance eligibility for patients and assist with referral issues
• Prepare and review claims for submission to clearinghouse following all insurance carrier guidelines
• File electronic Medicaid claims in accordance with state Medicaid rules
• Perform Surgery billing and apply modifiers per Correct Coding Initiative
• Prioritize high dollar denied claims and appeals in aging report
• Maintain and review aging reports and take action on overdue accounts
• Apply Medicare LCD Articles as appropriate to claims and appeals
• Maintain confidentiality and strictly follow HIPAA and regulatory guidelines
• Follow Wheaton Eye Clinic customer service and Medicaid guidelines

Skills

Billing and reimbursement

Communication skills

CPT/ICD-10/HCPCS knowledge

Microsoft Office

HIPAA compliance

Education

High School Diploma or equivalent

Insurance and Billing Certificate

CPC/CPB/AHIMA certifications

Tools

Optum Encoder Pro

Microsoft Office

Excel

Job description

Wheaton Eye Clinic seeks a Medical Billing and Insurance Representative for a full-time role in Wheaton, IL. Responsibilities include handling medical claims, reviewing eligibility, and ensuring billings meet insurer guidelines.

Requirements include 1–2 years billing experience, high school diploma, and knowledge of CPT/ICD-10/HCPCS. Certification in CPC/CPB/AHIMA and Optum Encoder Pro are a plus. This is a non-remote position with competitive pay.