Job Title: Billing and Revenue Cycle Representative
Hours: Monday – Friday / 8:00 AM to 5:00 PM
Reports to: Insurance & Billing Department Team Lead
Salary: Competitive salary and benefit package provided. All inquiries are confidential.
Requirements:
Candidates should have up to date knowledge and understanding of the following: CPT, ICD-10, NCCI, Payer edits, Eligibility and Benefits, Obtaining Prior Authorization for procedures, Payer authorization processes to ensure payment as well as current CMS billing and reimbursement rules. Familiarity with Florida Debt Collection laws. Ophthalmology experience preferred, but not required.
Daily Responsibilities:
- Work closely with Patient Services Representatives by explaining Eligibility and Benefits upon patient inquiry
- Strong skills in obtaining Prior authorization for surgery and injections for retina
- Proficiency in the check in and check out processes at all office locations
- Obtain Eligibility and Benefits for daily schedules
- Proficiency with insurance plan benefits, including Vision
- Balancing check-out drawer, preparing deposit, transmission of paper checks to bank
- Ensure appropriate processing and follow up work is performed for each claim
- Answer patient questions regarding their account or balance
- Communication with insurance companies regarding delinquent balances, overpayments, underpayments, and completing the necessary steps to resolve the problem
- File appropriate appeals with insurance companies
- Post payments and appropriate non-payments from insurance companies
- Research and resolve inappropriate non-payments from insurance companies and handle viable refund requests
- Document all communications with patients and insurance companies in the PM
- Review patient balances with manager to determine appropriate step in the collections process
- Prepare and communicate with collection agency on new and previously placed accounts
- Review charity cases, probate cases, and bankruptcy cases and file/adjust accordingly upon approval from manager
- Assist in preparing monthly closing reports