Insurance Verification Specialist / Specialty Billing Representative

midatlanticretina; Mount Carmel Township (PA); On-site; USD 42,000 - 66,000; Full time

Benefits offered by this job

Hiring incentive

Job summary

Mid Atlantic Retina in Mount Carmel Township, PA seeks a Specialty Billing Specialist to verify benefits for specialty drug injections, determine patient responsibility, and secure pre-authorizations. You will liaise with insurers and AR to obtain payments and maintain up-to-date billing knowledge.

The role requires medical billing experience, familiarity with CPT and ICD-10, and proficiency with Microsoft Office.

Qualifications

• Medical billing experience preferred.
• Knowledge of benefit investigation including obtaining eligibility information, authorizations, and referrals.
• Experience with CPT codes and ICD-10. Microsoft Office Suite required.

Responsibilities

• Verifies all benefits for scheduled injection appointments.
• Evaluates patient responsibility and notes accurate collection amounts.
• Obtains pre-authorizations or pre-determinations for each patient treatment.
• Monitors schedules for add-ons and changes.
• Assists in general billing AR including claims follow up and insurance calls to obtain payment for specialty drugs.
• Identifies and resolves inconsistencies in accounts and system files.
• Acts as customer service representative for patient questions about accounts.
• Maintains up-to-date billing knowledge of insurance carriers and policies.
• Travels to other MAR locations as needed.
• Performs other duties as assigned.

Skills

Medical billing

Benefit investigation

CPT/ICD-10

Microsoft Office

Tools

Microsoft Office

Job description

This position is eligible for Mid Atlantic Retina's $1,000 Hiring Incentive! The hired candidate will receive $500 after successful completion of 90 days of employment and $500 after successful completion of 1 year of employment! Available to new hires only- not available to agency hires, internal transfers, or re-hires.

Job Type

Full Time

Benefits

Medical, Dental, Vision, Sick Time, Vacation Time, 7 Paid Holidays and more

Job Description

Specialty Billing is responsible for verifying all benefits as they pertain to specialty drug injections and all the co-pay assistance funds. They are also responsible for following up with accounts receivable for any necessary payer.

Essential Functions

1. Verifies all benefits for scheduled injection appointments.
2. Evaluates all benefits for patient responsibility and notates accurate collection amounts.
3. Obtains all necessary pre-authorizations or pre-determinations for each patient to have treatment with a specialty drug.
4. Monitors all assigned schedules for add-ons and changes.
5. Assists in general billing AR when needed including but not limited to claims follow up, calls to insurances and anything necessary to obtain payment for all specialty drugs.
6. Recognizes, interprets, and evaluates inconsistencies, discrepancies, and inaccuracies in accounts along with system files, and initiates appropriate corrective methods.
7. Act as customer service representative in person or by telephone for any patient's questions about their account.
8. Maintain up to date billing knowledge of insurance carriers and their clinical policies.
9. Works overtime as needed.
10. Travels to other MAR locations as needed.
11. Performs other duties as assigned.

Competencies

1. Problem Solving / Analysis - Creative problem solving within defined acceptable parameters. Identifies and resolves problems in a timely fashion.
2. Customer Service- Superior listening skills, professional demeanor, and appropriate firmness.
3. Conflict Resolution- Responds promptly to customer needs. Ability to handle difficult patient interactions relative to sensitive billing issues.
4. Detail Oriented - Ensure proper procedures, protocols and processes are complied with consistently.
5. Strong Interpersonal Skills- Works effectively with patients, employees, and physicians.
6. Creative problem solving within defined acceptable parameters.
7. Time Management- maintains high volume productivity level for essential functions.
8. Ethical Conduct - Maintains confidentiality.

Required Education and Experience

1. Medical billing experience preferred.
2. Knowledge of benefit investigation including obtaining eligibility information, authorizations, and referrals.
3. Experience with CPT codes and ICD-10. Microsoft Office Suite required.