Essential Duties and Responsibilities include the following. Other duties may be assigned. ● Accept and process all requests from payers for credentialing information/updates/new contracts and products. ● Conduct all follow up steps till payor approval/completion is obtained. ● Answer questions, process requests from staff/providers related to credentialing information. ● Checking eligibility and coordination of benefits verification for Ophthalmic procedures/services. ● Perform medical record management, including updating of records and prescriptions. ● Coordinate practice training for process improvements. ● Reviewing patient bills for accuracy and completeness and obtaining any missing information – Ophthalmic services. ● Preparing, reviewing, and transmitting claims using billing software (EPM), including electronic and paper claim processing. ● Submission of billing data to appropriate insurance providers. ● Achieve maximum reimbursement for services provided. ● Resolve denial instances. ● Perform posting charges. ● Maintain reports on various projects. ● Conduct audits of Practice Management System reports versus Revenue reports.
● Ability to organize, set priorities, work independently and work well with a diverse group of people is essential. ● Ability to work effectively as a team member with a strong collaborative management style. ● Ability to think and act strategically and proactively. ● Proficiency in reading, writing, and communicating in English. ● Excellent computer skills including Microsoft Office Suite (Outlook, Word, Excel). ● Knowledge of medical terminology, revenue cycle processes including: health insurance verifications, billing, collections, cash posting functions and coding is a plus. ● Solid understanding of billing software and EHR/EMR. "Eyefinity Practice Management" experience is a Plus. ● 3-5 years of experience in payment posting, denials/rejections and AR management. Experience with "Trizetto" clearing house is preferred. ● Reliable, and willing to work “night shift” in the Philippines. ● Understands Credentialing workflow.