POSITION SUMMARY

EVP Eyecare is a privately held, portfolio company of The Cortec Group. Based in Denver, Colorado, EVP owns and operates a super-regional network of eyecare practices and surgical centers that conduct business under premier brands in Colorado, Texas and Arizona. We believe that delivering on an outstanding patient experience starts with building an outstanding employee experience.

Our mission is to improve people’s lives through better vision and outstanding patient experiences.

The Billing Edits and Errors Specialist ensures the financial integrity of accounts receivable by performing established financial processes that enable and expedite billing and collection for medical services. This includes editing and resolving claims according to regulations and compliance guidelines, patient account research and resolution, insurance verification and benefit determinations, identification of reimbursement issues. This must be done in a timely and accurate manner, in accordance with provided work instructions.

Responsibilities:

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Review billing documents as assigned for submission to insurance plans and government entities (Medicare, Medicaid, Tricare, etc.). Clearing all edits necessary for clean claim submission.
• Refer all needed claims to proper management personnel when unable to achieve clean claim status for submission.
• Review and understand EOB's/RA's (Explanation of Benefits and Remittance Advice documents received from insurance payers and government entities.
• Process all required payments, adjustments to accounts when claim payment is received if required in client or company systems.
• Contact insurance plans and governments entities using online systems, email, and phone to resolve unpaid claims.
• Providing data to management on trends found with payers in claims adjudication process affecting claims payment.
• Answer billing calls from the billing queue and resolve customer issues.
• Assist with process design and redesign as needed.
• Maintain up to date knowledge of revenue cycle management and industry trends.
• Maintain a professional approach with confidentiality. Assures protection and privacy of health information as attained through written, electronic or oral disclosures.
• Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as company policies and procedures.
• Other duties as assigned.

Education

• High School Diploma or equivalent required, Bachelors Degree preferred.
• Coding Certificate is preferred.

Qualifications

• 3 years Healthcare Billing experience preferred.
• Knowledge of insurance plans and providers.
• Knowledge of claims and billing.
• A commitment to excellent customer service as well as a positive proactive attitude.
• Excellent communication and verbal skills including proper grammar.
• CPT, HCPCS, and ICD-10 knowledge.
• Professional appearance and demeanor are required.
• The COVID-19 vaccination is/may be a condition of employment.

Other Skills and Abilities

• Ability to multi-task and work well under pressure
• Familiarity with current software packages such as Microsoft Word, Excel and Outlook
• Familiarity with NextGen is preferable
• 10K by touch and type 50-60 wpm

PHYSICAL DEMANDS AND WORK ENVIRONMENT

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.

NOTE

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an at will relationship.