Medical Collections Specialist

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

As the MedicalCollections Specialist,you will be responsible for processing insurance claims, managing patient accounts, and resolving unpaid or rejected claims for ophthalmology and optometry patients. You will maintain accurate claim and account information, post insurance and patient payments as needed, respond to account inquiries, and document all patient interactions.

What You'll Do:

• 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.

What You'll Need:

• Two years of full-time medical billing experience, which includes proficiency working in electronic health record systems, CPT and ICD-10 coding, posting payments and clinic billing; OR an equivalent combination of related training and experience.
• Knowledge of electronic health record system used by department.
• Ability to read and interpret insurance remittance advice.
• Ability to collect, verify and enter data; present information and data in report format.
• Ability to prioritize work to ensure established timelines are met.
• Ability to follow directions and carry out projects independently
• Ability to identify problems and find solutions.
• Ability to communicate effectively, both orally and in writing.
• Ability to maintain confidentiality of information encountered in the course of work and adhere to all HIPAA guidelines/regulations.