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Eye Care Coordinator
4 months ago
**SUMMARY**:
In-depth knowledge of Procedural Coding. Specialist in identifying appropriate ICD-10 coding based on CMS/HCC categories, CPT, HCPCS and CMS guidelines. Knowledge in processes for Super Bill, Electronic Claims Submission, Clearing House Operations, EOB, patient payments, denials, appeals, referrals, and authorizations.
**QUALIFICATIONS/EDUCATION**:
- High School Diploma or equivalent
- Bi-lingual English/Spanish preferred; must be able to read, write and speak fluent English.
- 1-2 years of experience in Customer Service preferred
- Strong people skill; independent decision making and customer service oriented.
- Billing and/or referrals experience preferred.
**CERTIFICATIONS/LICENSES**:
- CPC, CCS, or NCCT Certified-Preferred
**ABILIITES/SKILLS**
- Basic computer skills to be able to recognize and understand our appointment system.
- Excellent communication, Customer Service and telephone skills.
- Cheerful, pleasant, knowledgeable and professional demeanor, must always display a smile.
- Strong organizational skills and ability to multi-task effectively.
- Detail oriented and able to work efficiently in a stressful environment.
- Strong sense of teamwork and be able to manage high volume of interpersonal relationships with tact and diplomacy.
- Must be able to work independently and relate well with all levels of individuals within the organization.
- Able to respect and maintain patient confidentiality at all times.
- Must be able to follow policies and procedures and work flexible schedule and location.
- Must be able to work with the Practice Management and/or Electronic Health Record System.
**SUPERVISORY RESPONSIBILITIES**:
- N/A
**ESSENTIAL DUTIES AND RESPONSIBILITIES**
- Data entry in HER and payer portals.
- Obtain authorizations for Specialty encounters.
- Reconciles daily encounter activity, authorizations, billing.
- Review medical records to identify appropriate ICD-10 and CPT coding based on CMS categories.
- Creating and submitting insurance claims to different insurance companies.
- Process encounters for billing, statements, reimbursement claims, post transaction and data.
- Proper documentation to different level of appeals based on insurance denials.
- Deals with queries and responds via telephone, portal, or in writing.
- Must verify insurances as necessary.
- Communicating with insurance companies for claim(s) payment/denials/rejections.
- May collect patient payments and ensure payments are properly recorded and processed.
- Run daily and monthly reports.
- Conducts all activities in a polite, courteous and professional manner and abides by company policies and procedures.
- Maintain work area clean and organized at all times.
- Complies with HIPAA regulations.
- Fill prescriptions from optometrists and ophthalmologists.
- Conduct basic eye examinations.
- Take customers’ eye measurements.
- Assist customers in choosing eyeglasses and frames.
- Help eye patients decide which lens types are apt for them.
- Keep customer prescriptions and records up to date in EHR and lab portal.
- Repair broken or damaged glasses and frames or send them to lab for repair and maintenance.
- Performs other duties as assigned.
