Billing Specialist

POSITION SUMMARY

EVP Eyecare is a privately held, portfolio company of The Cortec Group. Based in Denver, Colorado, EVP owns and operates a super-regional network of eyecare practices and surgical centers that conduct business under premier brands in Colorado, Texas and Arizona. We believe that delivering on an outstanding patient experience starts with building an outstanding employee experience.

Our mission is to improve people’s lives through better vision and outstanding patient experiences.

The Billing Edits and Errors Specialist ensures the financial integrity of accounts receivable by performing established processes that enable and expedite billing and collection for medical services. This includes editing and resolving claims according to regulations and compliance guidelines, patient account research and resolution, insurance verification and benefit determinations, identification of reimbursement issues. This must be done in a timely and accurate manner, in accordance with provided work instructions.

Responsibilities:

ESSENTIAL DUTIES AND RESPONSIBILITIES

· Review billing reports assigned for timely submission of claims to insurance plans and government entities (Medicare, Medicaid, Tricare, etc.). Clearing all edits necessary for clean claim submission.

· Refer all needed claims to proper management personnel when unable to achieve clean claim status for submission.

· Review and understand EOB's/RA's (Explanation of Benefits and Remittance Advice documents received from insurance payers and government entities.

· Process all required payments and adjustments to accounts when payment is received if required in client or company systems.

· Providing data to management on trends found with payers in claims adjudication process affecting claims payment.

· Answer billing calls from the billing queue and resolve customer issues as needed.

· Assist with workflow processes and recommend efficiencies as needed.

· Maintains strict confidentiality; adheres to HIPAA guidelines and regulations

· Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as company policies and procedures.

· Other duties as assigned

Productivity Ranges:

· 40-60 Claims Worked per Day.

Education

· High School Diploma or equivalent required, Bachelor’s Degree preferred.

· Coding Certificate is preferred.