Billing Specialist

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 across Colorado, Texas, and Arizona.

The Billing Edits and Errors Specialist helps ensure the financial integrity of accounts receivable by performing established processes that support and expedite billing and collection for medical services. This role is responsible for editing and resolving claims in accordance with regulations and compliance guidelines, researching and resolving patient accounts, verifying insurance and benefits, and identifying reimbursement issues in a timely and accurate manner.

Responsibilities

• Review billing reports assigned for timely submission of claims to insurance plans and government entities such as Medicare, Medicaid, and Tricare.
• Clear all edits necessary for clean claim submission.
• Refer claims to management when clean claim status cannot be achieved.
• Review and understand EOBs and RAs received from insurance payers and government entities.
• Process required payments and adjustments to accounts when payment is received, as needed in client or company systems.
• Provide data to management on trends found with payers in the claims adjudication process that affect claim payment.
• Answer billing calls from the billing queue and resolve customer issues as needed.
• Assist with workflow processes and recommend efficiencies.
• Maintain strict confidentiality and adhere to HIPAA guidelines and regulations.
• Comply with applicable federal and state laws, company policies, and procedures.
• Perform other duties as assigned.

Productivity Expectations

• 40-60 claims worked per day.