Billing Specialist (Optometry)

We are seeking a skilled and detail-oriented Insurance Billing Specialist to join our offshore team, supporting an optometry practice in the United States. The ideal candidate will handle end-to-end billing tasks, including direct claim submission on insurance portals, working on claim rejections/denials, and managing reports. Familiarity with Practice Fusion EHR and U.S. insurance workflows is preferred.

Key Responsibilities:

1. Claims Submission:
• Submit insurance claims directly on payer portals based on data from Practice Fusion.
• Ensure accurate and timely submission by adhering to payer-specific requirements.
2. Rejection and Denial Resolution:
• Monitor payer portals for claim rejections or denials.
• Investigate reasons for rejection or denial, correct errors, and resubmit claims.
• Escalate unresolved issues to the onshore team for support or additional documentation.
3. Invoice and Patient Billing:
• Assist in generating patient invoices using data from Practice Fusion.
• Collaborate with the onshore team to address patient billing questions or disputes.
4. Data Management and Reporting:
• Maintain accurate records of submitted claims, denials, and payment statuses.
• Prepare regular performance reports, highlighting trends and opportunities for improvement.
5. Communication and Collaboration:
• Liaise with the onshore team to address questions about billing workflows or complex claims.
• Attend virtual meetings to review processes and resolve challenges.
6. Compliance:
• Adhere to HIPAA and payer-specific regulations regarding data privacy and claims handling.
• Ensure all billing activities are compliant with federal and state guidelines.

Qualifications:

• Education: Bachelor’s degree or relevant experience in medical billing or healthcare administration.
• Experience:
• At least 2 years of experience in medical billing, preferably in optometry or healthcare settings.
• Familiarity with U.S. insurance payers and portal-based workflows.
• Technical Skills:
• Proficiency in Practice Fusion or similar EHR platforms.
• Experience navigating insurance payer websites for claim submission and data retrieval.
• Strong Excel skills for reporting and tracking.
• Soft Skills:
• Exceptional attention to detail and problem-solving skills.
• Excellent written and verbal communication in English.
• Ability to manage priorities in a fast-paced environment.

Work Hours and Tools:
• Secure remote access to Practice Fusion and payer portals for billing activities

KPIs (Key Performance Indicators):

• Timely claim submission (95%+ accuracy).
• Resolution of claim rejections/denials within 7 business days.
• Monthly reduction in outstanding accounts receivable (as per practice benchmarks).

We are seeking a skilled and detail-oriented Insurance Billing Specialist to join our offshore team, supporting an optometry practice in the United States. The ideal candidate will handle end-to-end billing tasks, including direct claim submission on insurance portals, working on claim rejections/denials, and managing reports. Familiarity with Practice Fusion EHR and U.S. insurance workflows is preferred.