Billing Rep II

Major Responsibilities:

• Determines who the financial responsible party is for eyewear and eye care and processes the billing appropriately. Reviews more complex accounts for any internal or external problems that may cause a delay in payment. Analyzes available information and decides course of action. Assists teams with more complex problem accounts as needed.
• Contacts insurance companies or any other person, organization or department whose assistance is needed to obtain payment of vision claim, until it is paid or rejected. Responds to telephone or written inquiries from insurance companies, employers, state agencies and patients regarding insurance claims. Process rejections by billing the patient; or resolving problems, and having the claim resubmitted for payment. Applies contractual allowances where necessary.
• Enters insurance information and charges for optical products and services, bills third party plans, receives payments and processes them. Reviews billing work queues to determine who should be billed for eye care services and processes the charges to the appropriate party.
• Trains optical staff in the proper methods of processing third party claims, process the "work queue", and entering third party orders in the optical software.
• Applies third party payments to individual accounts for Aurora optical shops, determines the patients responsibility and sends statements.
• Acts as a liaison and resource between the optical dispensaries, internal departments, and external third party groups to centralize the communication, reduce the duplication of correspondences, ensure accuracy, and eliminate distractions from the optical staffs primary patient care responsibilities.
• Identifies and reports trends that impact the accounts receivable process. Assists in identifying and implementing process improvement plans. Processes end of the month reports for all optical locations with an emphasis on accounts receivable balances, both patient and third party.
• Assist in evaluating current and potential third party plans to determine if the organization should participate in the plan and determine the appropriate method to administer the plan.
• Assists patients with processing third party claims and/or concerns.
• Reviews the patients products and services provided and helps internal and external customers with interpretation and application decisions.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 3 years of experience in billing including experience in processing claims and accounts receivable.

Knowledge, Skills & Abilities Required:

• Must have a detailed understanding of third party plans.
• Basic computer skills including use of Microsoft Office products (Word and Excel) or similar products.
• Proficient knowledge base and understanding of departmental specific billing procedures and patient account systems.
• Demonstrated ability to function as a resources to staff on complex billing issues.
• Problem solving, conflict resolution, customer service, and good analytical skills are necessary.
• Excellent communication and organizational skills.
• Ability to manage multiple demands, tasks and projects at one time.

Physical Requirements and Working Conditions:

• Must be able to sit the majority of the workday.
• Occasionally lifts up to 10 lbs.
• Exposed to a normal office environment.
• May be exposed to weather and road conditions due to travel.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.