Medical Billing and Insurance Representative

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

Medical Billing and Insurance Representative

Full-time Regular - 30 hrs or more Wheaton, IL, US

3 days ago Requisition ID: 2269

Salary Range: $20.00 To $23.00 Hourly

About Wheaton Eye Clinic

Founded over 80 years ago, the Wheaton Eye Clinic is a nationally recognized multi-subspecialty ophthalmology practice that spans the western suburbs of Chicago and is the largest independent ophthalmology clinic in the Midwest. We pride ourselves on serving the community both as a caring eye care provider and as a reputable employer. Our offices are located in Wheaton, Naperville, Hinsdale, Saint Charles, Bartlett, and Plainfield and an ophthalmology-specific ambulatory surgery center at the main office in Wheaton. We currently have 34 ophthalmologists and 6 optometrists in every ophthalmic subspecialty are highly respected in the region and have superb relationships with referring colleagues and health systems. Patients travel to Wheaton Eye Clinic from throughout Northern Illinois, as well as from across the United States. Our referring physicians locally, across the United States, and from many international countries, send their patients to Wheaton Eye Clinic because of its unwavering reputation for exceptional patient care. More than 170,000 patient visits occur each year. Our mission at Wheaton Eye Clinic is to provide comprehensive eye care services of the highest quality and value. This dedication to excellence is founded on how we strive to surpass each patient’s expectations in the delivery of competent, timely, and compassionate eye care.

The Billing and Insurance Representative is responsible for any or all aspects of the medical claims and billing process for the Wheaton Eye Clinic. The Billing and Insurance will review claims to ensure billing requirements have been met and provide follow-up on any concerns, determine and apply adjustments, answer inquiries and update accounts as necessary. THIS IS NOT A REMOTE ROLE.

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

Education:

• High School Diploma or equivalent
• Insurance and Billing Certificate helpful
• CPC, CPB, AHIMA certifications a plus
• Optum Encoder Pro
• Strong working knowledge of Microsoft Office ( Excel, Word, Outlook)

Qualifications/Requirements

• 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.
• Understanding of basic medical terminology and anatomy.
• Ability to understand remittance advice, EOB’s and payor correspondence and research denial reasons.
• Ability to maintain positive relationships with patients, staff and insurance carriers.

Competitive salary and benefit package, generous 401K program.

EOE