Medical Billing Specialist

Canton, Ohio
About Vitreo-Retinal Consultants, Inc.

Vitreo-Retinal Consultants, Inc. is a private practice ophthalmology group of fellowship-trained retinal specialists. We provide state-of-the-art retinal care for diseases which include Diabetic Retinopathy, Macular Degeneration and Retinal Detachment. Our physicians are available for consultations and emergencies.

Job Overview

Vitreo-Retinal Consultants, Inc. is continuing to grow, and we are looking to expand our team by adding an experienced medical billing specialist.

Position Summary

The Billing Specialist will work directly with the billing manager. The billing specialist must possess thorough working knowledge with the skills to independently and appropriately work accounts receivable. This includes the ability to answer billing inquiries from patients and office staff, possess a working knowledge of both the practice management and electronic medical records, have the ability and knowledge to electronically submit claims, post electronic payments and work denied claims appropriately. The billing specialist should have the capability to assist other team members as needed while maintaining their independent responsibilities. Our goal is to ensure that all physicians services are billed in a timely and accurate manner to allow for the highest reimbursement.

Duties and Responsibilities:

• Read and understand explanation of benefits

• Knowledge of CPT codes, Modifiers, and ICD-10 codes

• High level understanding of common denials (LCD, NDC, CLIA, bundling, etc.)

• Assure all charges are entered correctly and balance multiple office charges and payments

• Make necessary changes to patient accounts (address, name, telephone number, and insurance changes, etc.)

• Insurance verification

• Knowledge of prior authorization process

• Assure that all electronic and paper claims are sent out timely

• Review and work claim edits and rejections daily

• Assist in posting all patient and insurance payments

• Prepare and send appeals

• Identify payor related issues and report them to the billing manager

• Answer telephone calls regarding billing inquiries

• Submit copies of overpaid accounts to billing manager for review

• Send accounts to collections based on practice policy

• Assist with setting up patient payment plans

• Assist in training new employees

• Maintain strictest confidentiality of patient private health information (PHI) by disclosing only the information requested.

• Perform additional duties as assigned by management


• High school graduate or equivalent

• Minimum of 3-5 years of experience in medical billing

• Ability to read, understand and follow both written and oral instructions; and follow practice policies

• Ability to professionally communicate with patients and co-workers

• Ability to speak clearly and concisely

• Ability to use correct grammar, correct spelling and punctuation usage is required in notes and emails

• Ability to multi-task

• Ability to operate a telephone system

• Knowledge of how to utilize office equipment, computers, copier, fax, and scanner

• Knowledge of and experience with working unpaid claims for all insurance payers such as Medicare, Medicaid, Anthem, etc.

• Previous experience in a customer service environment

• Organize and prioritize responsibilities while remaining flexible to changing demands

• Ability to meet deadlines and work under pressure with minimal supervision

• Strong analytical skills and attention to detail

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