Insurance Verification Specialist
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Job Description
Insurance Verification Specialist managing claims, authorizations, and patient balances for a large ophthalmology care network. Ensuring accurate billing and patient-centered financial communication.
Responsibilities:
- File insurance claims and manage patient accounts
- Answer inquiries about account status and charges from ophthalmology surgery patients
- Collect surgery patients’ insurance information
- Communicate with patients to quote day-of-surgery costs
- Post surgery charges and payments
- Obtain prior authorization for procedures as needed
- Document customer interactions in the appropriate computer system
- Enter and submit professional and facility insurance claims
- Process claims through practice management and EHR systems
- Verify insurance eligibility, benefits, authorizations, coverage limits, and patient financial responsibility
- Explain copays, deductibles, coinsurance, out-of-pocket expenses, and coverage determinations
- Follow up on denied, rejected, unpaid, or underpaid claims and resubmit as needed
- Post charges, insurance payments, patient payments, adjustments, and refunds
- Submit secondary claims and manage coordination of benefits
- Monitor and collect outstanding patient balances, including soft collection activities
- Perform daily balancing procedures and maintain accurate financial records
- Ensure compliance with HIPAA regulations and payer guidelines
- Meet productivity, quality, and service standards
- Collaborate with providers, patients, insurance carriers, and team members
- Perform other duties and special projects as assigned
Requirements:
- High School Diploma
- Computer skills including experience with a Windows Operating System, e-mail, and data entry
- Ability to look up ICD-10 diagnosis and CPT treatment codes from online service or traditional coding references
- Prior experience with medical billing software
- At least one year of insurance billing experience in a previous job
- 2 years of experience in a medical office setting
- Prior experience in an Optometry/Ophthalmology practice
- Prior experience with Compulink software
- Willingness to submit to a background check
- Annual compliance training is required
- Compliance with HIPAA, OSHA, and company policies is required
- Ability to remain stationary for extended periods
- Frequent use of hands, fingers, and computer equipment
- Ability to communicate effectively with patients and team members
- Ability to occasionally lift, carry, push, or pull up to 25 pounds
Benefits:
- Paid Training & Career Development
- Growth & Advancement Opportunities
- Supportive Team Environment
- Competitive Benefits Package
- Tuition Reimbursement Opportunities
- Employee Eyewear Discounts
- Referral Bonus Program
- Medical, Dental & Vision Insurance
- 401(k)
- Paid Time Off & Holidays
- Life & Disability Insurance
- Tuition Reimbursement
- Continuing Education Support
- Certification Sponsorship
- Referral Bonus Opportunities
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