Medical Claims & Collections Specialist - Ophthalmology

Center for Advanced Eye Care; Wilmington (DE); On-site; USD 42,000 - 62,000; Full time

Job summary

Center for Advanced Eye Care is seeking a Medical Collections Specialist to process insurance claims, post payments, and manage patient accounts for ophthalmology and optometry patients.

You will resolve unpaid or rejected claims, prepare appeal letters, verify eligibility, respond to inquiries, and maintain HIPAA confidentiality. This on-site role requires 2 years of medical billing experience and strong communication.

Qualifications

• Two years of full-time medical billing experience, including proficiency with electronic health record systems, CPT and ICD-10 coding, posting payments and clinic billing.
• Knowledge of the electronic health record system used by the department.
• Ability to read and interpret insurance remittance advice.
• Ability to collect, verify and enter data; present information and data in report format.

Responsibilities

• Process and submit electronic and paper claims daily.
• Review and work denials in the workflow system for tasks without a payer response once past 30 days from billing.
• Follow up with insurance companies on unpaid or rejected claims. Resolve issues and re-submit claims.
• Prepare appeal letters to insurance carriers when not in agreement with claim denial. Collect necessary information to accompany appeal.
• Prepare and submit secondary claim upon processing by primary insurer.
• Verify patient benefits, eligibility and coverage.
• Process patient and insurance carrier refunds.
• Communicate with Finance and Operations Management on issues with collections.
• Work credit balances on the aging and overpayment account and follow the credit balance procedure for resolution.
• Answer patient inquiries regarding account status professionally, accurately, and timely; Maintain HIPAA confidentiality of patients.

Skills

Medical billing

HIPAA compliance

EHR systems

CPT/ICD-10 coding

Data entry

Communication skills

Tools

Electronic Health Record (EHR)

Job description

Center for Advanced Eye Care is seeking a Medical Collections Specialist to process insurance claims, post payments, and manage patient accounts for ophthalmology and optometry patients.

You will resolve unpaid or rejected claims, prepare appeal letters, verify eligibility, respond to inquiries, and maintain HIPAA confidentiality. This on-site role requires 2 years of medical billing experience and strong communication.