Managed Vision Care - Billing Operations Associate

Colonial Group; San Antonio (TX); Remote; USD 30,000 - 38,000; Full time

Job summary

Visionworks is seeking a Billing Specialist to ensure accurate, compliant, timely billing and reimbursement for professional vision and medical exams across vision insurance payers. This remote, full-time role involves submitting claims, posting payments, handling adjustments, and pursuing follow-up and collections in a managed care environment.

You will work with store teams to ensure proper demographics and authorizations, analyze denials, process appeals, and generate patient balance

Qualifications

• Zero to one (1) years of experience in medical insurance claims billing preferred.
• Proficient in MS Excel and Word.
• 10-Key by touch.

Responsibilities

• Prepare and submit clean claims to various insurance companies either electronically or by paper in accordance with payer guidelines and contract requirements.
• Analyze and correct first pass rejected claims for completeness and accuracy of information for second pass clean claim submission.
• Research and perform all primary and secondary billing claim status follow up activities for assigned insurance plans.
• Review, evaluate and process all claim appeals through resubmission to insurance carriers with complete and accurate supporting documentation.
• Research and recommend any third party customer account adjustments and/or write-offs to Manager based upon collectability of account.
• Support and assist store associates with ensuring all proper customer demographic and authorizations are present for clean claim submittal to insurance carriers for accurate claims processing and payment.
• Recognize and report claims problems, errors, and discrepancies to management in order to proactively identify and effectively resolve billing trends in a timely manner.
• Generate and submit monthly patient balance due statements to customers as dictated by the explanation of benefits received from their insurance carrier.

Skills

MS Excel

MS Word

10-Key by touch

Verbal communication

Written communication

Education

High School Diploma or GED

Job description

Summary

The purpose of this position is to ensure accurate, compliant, timely billing and appropriate reimbursement for all professional vision or medical exams and vision material services from all vision insurance payers. This may include accurate and timely identification and completion of point of sale customer account, billing, payment posting, contractual write-offs, adjustments, follow-up, and collection of unpaid accounts, per state and federal insurance regulations for members receiving services at Visionworks retail stores.

Pay Class and Pay

Pay Class: Full Time and Remote

Pay Rate: $14.54 - $18.18

Essential Responsibilities

1. Prepare and submit clean claims to various insurance companies either electronically or by paper in accordance with specific payer guidelines and/or contract requirements


2. Analyze and correct first pass rejected claims for completeness and accuracy of information for second pass clean claim submission


3. Research and perform all primary and secondary billing claim status follow up activities for assigned insurance plans


4. Review, evaluate and process all claim appeals through resubmission to insurance carriers with complete and accurate supporting documentation required


5. Research and recommend any third party customer account adjustments and/or write-offs to Manager based upon collectability of account


6. Support and assist store associates with ensuring all proper customer demographic and authorizations are present for clean claim submittal to insurance carriers for accurate claims processing and payment


7. Recognize and report claims problems, errors, and discrepancies to management in order to proactively identify and effectively resolve billing trends in a timely manner


8. Generate and submit monthly patient balance due statements to customers as dictated by the explanation of benefits received from their insurance carrier

Education

• High School Diploma, GED, or equivalent work experience

Experience & Background

• Zero to one (1) years of experience in medical insurance claims billing preferred


• Proficient in MS Excel and Word.


• 10-Key by touch.

Language Skills

• Well-developed verbal, listening and phone communication skills


• Good written communication skills with the ability to write routine correspondence

Mathematical Skills

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

Reasoning Ability

• Ability to define problems, collect data, establish facts, and identify trends.


• Ability to exercise good judgment and elevate issues appropriately

Essential Responsibilities related to Physical Demands/Work Environment

The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the associate is required to stand, use hands and fingers to handle, feel, pick or pinch, and talk or hear most of the time. The associate is occasionally required to stand, walk, and reach with hands and arms. The associate must frequently lift and/or move up to 20 pounds. The noise level in this location is moderate (use of computers, printers and machines).

• Stand: x


• Walk: x


• Sit: x


• Use hands to finger, handle, or feel: x


• Reach with Hands and Arms: x


• Climb or balance: x


• Stoop, kneel, crouch, or crawl: x


• Talk or hear: x


• Close Vision (clear vision at 20\" or less): x

Essential Responsibilities related to Behavioral Characteristics

• Strong organizational skills and ability to execute manual detailed tasks.


• Strong customer service focus and commitment.


• Ability to establish and maintain effective working relationships within the team.


• Ability to work well with diverse personalities.


• Tactful, mature and flexible.


• Ability to work onsite and participate in interactive onsite meetings on a regular and predictable basis.


• Ability to initiate immediate interaction, coordination and collaboration with team members, clients, customers etc.

HIPAA & Security Requirements

All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.

Visionworks is an equal opportunity employer, committed to the hiring, advancement, and fair treatment of individuals without regard to race, color, religion, sex, age, sexual orientation, gender, gender identity, national origin, ethnicity, disability or veteran status, or any other protected status designated by federal, state, or local law.

The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria considered necessary to perform the job successfully. As required by changing business needs, complete additional essential responsibilities as identified and assigned.

For roles that are remote (i.e., Work From Home (WFM)) or hybrid (i.e., partial onsite at a VSP location and WFM), must demonstrate a high level of engagement in virtual environments, including maintaining camera presence during meetings to support effective communication and team alignment.