Job Details

Retinal Billing Specialist

Department: Central Billing Office Reports To: CBO Manager

Job Summary:

The Retinal Billing Specialist needs an understanding of the insurance claims process including claims filing, posting insurance payments and working denials.

Primary Responsibilities:

1. Review, edit and accept charges from clinics based on proper use of ICD10 and CPT coding rules.
2. Identify potential denied/rejected claims and make corrections before submitting.
3. Communicate with clinic managers for additional information as needed.
4. Accurately post incoming payments from insurance carriers, including adjustment codes.
5. Identify, correct and rebill claims denied by insurance.
6. Assist patients calling with questions about statements, refunds and charges.
7. Take payments over the phone as needed.
8. Maintain positive working relationships with all MEI doctors and staff members.
9. Assist co-workers as needed.

Essential Skills and Abilities:

1. Teamwork is a must for this department.
2. Detail oriented and able to work in an active environment.
3. Excellent interpersonal and communication skills
4. Working knowledge of insurance claims process and terminology
5. Able to interpret insurance EOBs
6. Understanding of CPT and ICD10 coding as well as CMS basic guidelines.
7. Understanding of modifiers, clinical and surgical.
8. Handle patient phone calls compassionately and efficiently

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Requirements

Essential Skills and Abilities:

1. Excellent interpersonal and communication skills
2. Understand basic rules and regulations of CMS and commercial insurance carriers
3. Understanding of CPT and ICD-10 coding
4. Understanding of modifiers
5. Ability to interact with patients, doctors, co-workers and management in a team-oriented environment
6. Handle patient phone calls compassionately and efficiently
7. Computer literate including knowledge of Microsoft Word
8. Bookkeeping skills and a working knowledge of medical billing software

Education and Experience:

1. High school diploma or equivalent
2. Two years of medical billing experience