EyeCare Services Partners (ESP) is creating the nation’s leading eyecare services company in both quality and scale by consolidating opthalmologic and optometric practices and ambulatory surgery centers that are locally dominant and clinically differentiated.
The Certifed Coder responsibilities will include processing a specific sub-set of medical and/or vision claims generated within the practice management software system daily. Batches will be created for each location assigned, claim edits reviewed and appropriate action taken to ensure that claims are clean prior to processing to payors.
Primarily responsible for a certain sub-set of claim edits, denials, and other related functions.
Responsibilities will include processing medical and/or vision claims generated within the practice management software system daily. Batches will be created for each location assigned, claim edits reviewed and appropriate action taken to ensure that claims are clean prior to processing to payors.
AR Follow Up:
Responsibilities will include AR follow-up with insurance payors to correct denied claims including submission of appeal letters, correct claims in accordance with Correct Coding Initiatives (CCI) and all Compliance regulations and work with the clinics to gather information needed to correct and reprocess the claim. Communication of denial trends to Supervisor and Manager to help initiate training to avoid potential denials in the future.
Other Duties and Responsibilities:
- Create claim batches and process all insurance claims daily
- Understanding of claim edits and know the appropriate actions to take to correct the claim prior to submission
- Prepare claim resubmissions, appeals and reviews
- Research correct ICD and CPT codes to get claims paid for any rejections
- Contact patient when necessary to obtain correct information to get the claim paid
- Call insurance company when necessary to find out why claim is rejecting, and follow through by correcting information and resubmitting the claim for payment
- Work with clinics to gather additional information that may be needed to correct a claim for submission to payor
- Contact patient when necessary to obtain correct information to get the claim billed
- Meet timely deadlines specified by management when billing charges
- Maintain organized filing system for uploaded batches
- Support and backup other areas of the department as needed
- CPC/AOA certified
- Undergraduate Degree preferred
- Medical collections experience preferred
- Customer service experience preferred
- Experience in Ophthalmology and NextGen is preferred
In Return We Will Offer:
- Benefits to full time team members that include: comprehensive medical, dental and optical coverage, 401k and short and long term disability
- Company paid life insurance
- Paid holidays and generous paid time off
- Paid parking where applicable
- Team oriented working environment where you are heard and respected
- Clear career ladder opportunities
To learn more about us, please visit: www.espmgmt.com Benefits to full time team members that include comprehensive medical, dental and optical coverage, 401K and short and long term disability