Overview of Position

Medical A/R Specialist is responsible for calling all insurance companies and utilizing online resources to check claim status, resubmit claims as necessary via paper or electronically, file appeals, track denial trending, resolve denials, and ensure maximum revenue capture. In addition, this role will facilitate timely receipt of payments and ensure balances on accounts are correct and appropriately prorated.

Eyecare Services Partners selects best-in-class Ophthalmic and Optometric practices that are focused on essential eye health issues. Our practice groups excel in the utilization of advanced technology and processes to provide safe and optimal outcomes for our practices.ESP and our associated practices represent a community of dedicated leaders, compassionate providers and surgeons, plus highly skilled clinical teams supporting communities and their eye care needs.

***Eyecare Services Partners will now only consider candidates who can verify prior to hire that they either have been fully vaccinated against the Covid 19 virus or have started the vaccine process by having their initial dose before starting in their new position and are committed to completing that process within 30 days of starting work, to include the Booster. Your signature on this document will also mean that you will comply with this Covid 19 vaccination requirement.

Job Duties and Expected Performances:

• Identify the root cause of insurance denials, send appeals to payors, and take appropriate actions to assure prompt payment.
• Review encounters via NextGen, reports, and other sources with an average productivity of 50 accounts per day.
• Document follow-up appropriately in the practice management system.
• Register with all necessary payor portals and submit all the required verification documents for access.
• Maintain an acceptable error rate and productivity level within department policy.
• Perform collection actions, including third-party appeals and resubmitting claims to third-party payers.
• Identify and bill secondary or tertiary insurances.
• Reconcile carrier submissions, edits, and rejection reports.
• Resolve incoming patient calls with excellent customer service skills.
• Employ tactfulness in dealing with insurance companies/patients regarding accounts in verbal and written communication while being professional and courteous at all times.
• Identify, verify, and document adjustments according to established policies and procedures.
• Research and prepare credits for refund approval.
• Performs all other duties as assigned by direct report.

Required:

• High School Graduate or General Education Degree (GED)
• Associates degree

Experience:

• Three years of professional medical billing and collecting experience or certification obtained from a nationally accredited billing program, i.e., CMBS (Certified Medical Billing Specialist). Required
• One year of optical billing experience, including medically necessary contact lenses
• One year of patient collection experience
• Experience with Excel and Windows-based programs.
• Experience in performing tasks that require a basic understanding of accounting and math skills.

Preferred Experience

• + Experience NextGen PM/EHR
• + One year of Optometry and Ophthalmology third-party billing guidelines and expertise.