Billing Associate

The Billing Associate position is responsible for working with insurance companies, state agencies, and patients in resolving outstanding account balances, research and resolve problem accounts as needed, and maximize collections to achieve collection performance goals.

The Billing Associate in the Self-Pay / Patient Financial Services team work to improve A/R through service-oriented patient communications and case tracking..

ESSENTIAL FUNCTIONS:

To perform this job successfully, an individual must be able to perform each essential function satisfactorily with or without accommodation. The requirements listed below are representative, but not all inclusive, of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

• Responsible for all aspects of follow up and collections, including making telephone calls and accessing payer websites.
• Identify trends and perform root cause analysis on unpaid and underpaid claims.
• Research, appeal, and resolve claim rejections, underpayments, and denials with appropriate insurance payor.
• Initiate telephone or letter contact to patients to obtain additional information as needed.
• Accurately and thoroughly documents the pertinent collection activity performed.
• Develop and maintain positive working relationships with clinical personnel, co-workers, and insurance representatives.
• Maintains an appropriate professional appearance and demeanor in accordance with Company policies.
• Keep commitments and keep direct supervisor informed of work progress, timetables, and issues.
• Maintain strict compliance with State, Federal and other regulations (e.g., OSHA, WC, HIPAA, ADA, FEHA, DOL, HR policies and practices).
• Other duties as assigned by management.

Requirements

REQUIRED : At least 2 or more years of related work experience. Operational management knowledge of medical offices. Equivalent to high school diploma or general education degree (GED).

DESIRABLE : Associates or Bachelor's Degree. Knowledge of MS Office Suite and Care Cloud applications. Experience in the Ophthalmic industry.

CERTIFICATES/LICENSES/REGISTRATIONS:

• AHIMA or AAPC Certified Coding Specialists or Certified Professional Coder (preferred)

KNOWLEDGE/SKILLS/ABILITIES/TALENTS:

• Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• Knowledge of HCPCS, CPT, and ICD-10 coding.
• Results Oriented (Energetic self-starter; sets realistic goals; meets commitments; persistent, prioritizes daily to achieve results).
• Customer Service Advocate (flexible and adaptive; empathetic; passionate; ethical).
• Ability to respond to common inquiries from customers, staff, vendors, or other members of the community.
• Ability to draw valid conclusions, apply sound judgment in making decisions, and to make decisions under pressure; ability to interpret and apply policies and procedures.
• Must address others professionally and respectfully by actions, words and deeds.
• Detail oriented, organized, process focused, problem solver, self-motivated proactive, customer service focused.
• Displays independent judgment by willingness to make timely and accurate decisions based on available information that is sometimes vague or limited in nature.
• Ability to multitask effectively and work in a fast paced and sometimes ambiguous environment, without compromising quality of work.
• Ability to prioritize tasks and projects with limited direction, while understanding and contributing to the success of the team.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• This is primarily an office classification. Temperature conditions are controlled with limited direct exposure to hazardous physical substances. The noise level in the work environment is usually low to moderate.
• While performing the duties of this job, the employee is regularly required to sit, stand, walk, handle, or feel, reach with hands and arms, see, talk and hear. The employee will frequently lift and/or carry reports, records and other materials that typically weigh less than 20 pounds. The employee is occasionally required to stoop, kneel, bend, or crouch.
• Finger dexterity is needed to access, enter, and retrieve data using a computer keyboard, calculator, and other standard office equipment.

All of the information contained herein reflect general details as necessary to describe the principal functions of this classification, the level of knowledge and skill typically required and the scope of responsibility, but should not be considered an all-inclusive listing of work requirements. Management reserves the rights to add, modify, change, or rescind the duties and/or work assignments of all positions, without advanced notice, and to make reasonable accommodations so that qualified employees can perform the essential functions of the job.

Notwithstanding any of the foregoing described job responsibilities, employee shall not engage in activities that constitute the practice of ophthalmology as prohibited under applicable law. Employee shall neither exercise control over nor interfere with the clinician-patient relationship. Clinicians shall have sole responsibility for all professional services provided to patients.