AR Specialist

Company Overview At Vitreo Retinal Associates, we’re more than a leading retina specialty practice—we’re a team dedicated to preserving and restoring vision for our patients. Specializing in advanced care for retinal conditions like macular degeneration, diabetic retinopathy, and retinal detachment, we combine cutting‑edge technology with compassionate, personalized treatment. Position Summary This positin is based full time onsite at the Gainesville office. The A/R Specialist is responsible for the company’s third-party medical claims processing and assisting patients and office staff with questions on insurance claims, authorizations, statements, and other billing issues. This position will prepare, submit and follow-up on medical claims for Managed Care Organization (MCO), Medicaid, Medicare, Other Federal, Private Insurance, and Workers Compensation. Responsibilities Files and processes primary and secondary third‑party medical Verifies all the information for claims processing is complete and Contacts the appropriate person to obtain missing or unclear billing Follows-up by website and/or telephone on all unpaid and denied claims to determine next course of action, which may require rebilling missing claims, denied claims or sending additional information on pending claims Sends appeal letters to insurance Obtains authorizations when needed. Identifies and corrects charge entry/ billing Provides proper documentation to insurance companies. Handles insurance company questions, complaints, and/or responds to and interacts with patients concerning all aspects of billing through phone, e‑mail, or regular mail in a prompt and courteous Documents all actions and maintains permanent records of patient Assists with answering phones, screening calls and following-up on Works with management on patient billing and insurance Processes refunds to patients and insurance Works with outside programs (i.e., co‑pay assistance) to ensure proper Communicates with front office staff to attempt to collect any outstanding patient Contributes to the team effort by completing other tasks and projects as needed Qualifications Minimum of two (2) years Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system CPC, CPOC, COC certifications a plus Six months of previous customer service experience preferred Prior experience with an electronic medical record system required (EHR/EMR) Working knowledge of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; and strong knowledge of Federal payer regulations Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes Ability to handle sensitive and confidential information in a professional manner Maintains knowledge of coordination of benefits requirements and processes Demonstrated success working in a team environment focused on meeting organization goals and objectives is necessary Self‑motivated with strong organizational skills and superior attention to detail Ability to review documents for accuracy and reasonability Ability to work well under pressure Ability to multi‑task, set priorities and follow through without direct supervision Effectively communicate with physicians, patients, insurers, colleagues, and staff Intermediate computer skills including Microsoft Office; especially Word, Excel, and PowerPoint Knowledge of policies and procedures to accurately answer questions from internal and external customers Detail oriented and tolerant of frequent interruptions and distractions from patients and staff Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external Exercises sound judgment in responding to inquiries; understands when to route inquiries to next level Team player that develops strong collaborative working relationships with internal partners and can effectively engage and ability to build consensus among cross‑functional teams Company Benefits We offer a competitive benefits package to our employees: Medical Dental Vision 401k w/ Match

HSA/FSA

Telemedicine Generous PTO Package We also offer the following benefits for FREE: Employee Discounts and Perks Employee Assistance Program Group Life/AD&D Short Term Disability Insurance Long Term Disability Insurance EyeSouth Partners is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

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