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Medical Billing and Insurance Representative
Wheaton Eye Clinic. Identify and resolve inquiries from patients, staff, and insurance companies .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical billing and reimbursement processes, including claims preparation and submission for commercial insurance, Medicare, and Medicaid. Proficient in applying coding standards and maintaining compliance with HIPAA and regulatory guidelines.
Highest-signal resume keywords
Medical Billing ExperienceCPT, ICD-10, HCPCS KnowledgeClaims Submission and ReviewInsurance and Billing CertificationOptum Encoder Pro Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims PreparationInsurance Eligibility DeterminationSurgery BillingModifier ApplicationAging Report ManagementRemittance Advice UnderstandingEOB AnalysisDenial ResearchBasic Medical TerminologyAnatomy Knowledge
Soft Skills
Excellent Communication SkillsRelationship Management
Tools & Technologies
Microsoft OfficeOptum Encoder Pro
Certifications & Qualifications
Insurance and Billing CertificateCPCCPBAHIMA Certification
Industry Keywords
HIPAA ComplianceMedicaid GuidelinesCorrect Coding InitiativePayor CorrespondenceHigh-Dollar Denied Claims
About the role
Key responsibilities & impact- Identify and resolve inquiries from patients, staff, and insurance companies
- Determine insurance eligibility for patients and assist with referral issues
- Prepare and review claims for submission to clearinghouse following insurance carrier guidelines
- File electronic Medicaid claims in accordance with state Medicaid rules
- Perform surgery billing and apply modifiers per Correct Coding Initiative
- Prioritize high-dollar denied claims and appeals in aging report
- Maintain and review aging reports and take action on overdue accounts
- Apply Medicare LCD Articles as appropriate to claims and appeals
- Maintain confidentiality and strictly follow HIPAA and regulatory guidelines
- Follow Wheaton Eye Clinic customer service and Medicaid guidelines
- Review claims, determine and apply adjustments, answer inquiries, and update accounts as necessary
Requirements
What you’ll need- High School Diploma or equivalent
- 1-2 years experience in billing and reimbursement for commercial insurance, Medicare and Medicaid
- Insurance and Billing Certificate helpful
- CPC, CPB, AHIMA certifications a plus
- Experience with Optum Encoder Pro
- Strong working knowledge of Microsoft Office (Excel, Word, Outlook)
- Knowledge of CPT, ICD-10, and HCPCS code sets and CCI edits
- Understanding of basic medical terminology and anatomy
- Ability to understand remittance advice, EOBs, and payor correspondence and research denial reasons
- Excellent verbal and written communication skills
- Ability to maintain positive relationships with patients, staff, and insurance carriers
Benefits
Comp & perks- Competitive salary
- Benefit package
- Generous 401K program