Medical Biller - Billing and Compliance Representative

Job Type Full-time Description The Medical Biller/Billing and Compliance Representative is responsible for managing complex billing processes to ensure accurate claims and optimize revenue. This role requires specialized knowledge of ophthalmic billing, coding and compliance. This position collaborates with the clinical and administrative teams to support Eyesight's financial goals and maintain clear, professional communication with patients and stakeholders. Requirements Core Behavioral Values: CLEAR ID: Collaborate, Learn, Empathy, Accountable, Respect, Integrity, Dedication These behaviors are based on Eyesight's culture and values critical to support the organizations mission of providing uncompromising care to patients. Essential Functions: Analyze current billing processes and identify areas for improvement to enhance efficiency, accuracy and overall revenue cycle management Responsible for oversight and optimization of surgery posting protocols to improve workflow efficiency Manage the posting of electronic funds transfer (EFTs) and other payments to patient accounts ensuring all payments are recorded accurately and timely Ensure compliance with ophthalmology specific coding guidelines including HIPAA, CPT, ICD-10, and maintain awareness if changes in regulations (e.g. MIPS) Manage the annual setup and continuous updates of fee schedules in EMA, ensuring accuracy and alignment with payer guidelines, and collaborates with the billing team to maintain efficient operations Generate regular billing and financial reports for management, providing insights into revenue trends, payer performance, A/R status, and billing department effectiveness Stay current on prior authorization requirements/processes and ensure timely and accurate submission of prior authorization requests Remain up to date with industry changes, including updates to Medicare and Medicaid billing guidelines Work closely with Surgical Coordinators and clinical staff to verify all necessary documentation is complete and accurate for billing purposes Other duties as requested Minimum Requirements (education and experience): High School graduate or GED is required 1 year in office setting Preferred: Experience working in a medical office Understanding of Ophthalmic language and terms Financial experience in bookkeeping, receivables and payables Proficiency in billing software and EHR systems Work Condition s: Typical office conditions Noise level is usually quiet Physical Requirements: Regularly required to sit, walk and stand Talk or hear, both in person and by telephone; Use hands repetitively to finger, handle, feel or operate standard office equipment; Reach with hands and arms; and lift up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision and the ability to adjust focus.

Created: 2024-11-03