Optometry Claims Coordinator 2

The Claims Coordinator is responsible for accurate and timely claims processing, effective management of patient accounts, ensuring accurate data collection within the OSU College of Optometry.

Primary responsibilities are:

1. Claims Processing & Accounts Receivable

• Claim Submission: Process and submit routine vision and medical vision insurance claims (e.g., Aetna, Medical Mutual, VSP) through practice management software via batch submission to the clearinghouse, manual entry into payer portals, or hard copy claims.
• Prior Authorization: Submit prior authorization requests via provider portal upon receiving necessary documentation from clinical staff or providers.
• Quality Assurance: Review Electronic Health Records (EHR) to verify correct coding ICD-10 and CPT, accurate posting of services/materials, and provider sign-off before finalizing and submitting claims.
• Claims Follow-up: Pull claim status information from provider portals, document payment and denial details on the patient's ledger, and make necessary corrections for timely claim resubmission and reprocessing.
• AR Management: Utilize and analyze insurance receivable reports to ensure accuracy across all patient accounts with pending insurance responsibility.
• Daily Deposit: Review patient payments, and insurance payments via check, and credit card payments.
• Patient Payment Portal: Posting, reconciling, and completing online payment deposit.
• Billing Support: Review patient statements for accuracy and coordinate the mailing process.

2. Patient Accounts & Support

• Billing Inquiries: Communicate clearly with patients and staff regarding account balances, explaining complex financial concepts such as copayments, co-insurance, deductibles, and maximum out-of-pocket expenses.
• Answering phones: Assist patient inquiring about their account balance, answer insurance inquiries about upcoming services/materials. Taking patient payment information over the phone.
• Payment Processing: Accept and apply patient payments accurately to account balances, providing receipts via USPS, secure email or secure fax.
• Collections: Initiate the initial steps for setting up customer numbers for patient accounts that require referral to collections.
• Informal Mentorship: Serve as a knowledgeable resource for newer or less experienced staff members on insurance procedures and common questions.

3. Post Appointment Insurance Verification & Data Management

• Eligibility and Benefit Verification: Proactively verify patient insurance eligibility, coverage, and benefits using specialized provider portals (e.g., Eyefinity, Clearwave, and Availity).
• Troubleshooting: Independently resolve routine insurance verification issues and works with clinic staff to gather complete and accurate information when portal data is insufficient.
• System Data Entry: Manually enter complete and accurate insurance details, including effective dates, member information, copayments, and co-insurance, into the practice management software (Compulink).
• Internal Communication: Create and manage patient alerts in Compulink to notify staff, Interns, and Attending providers of benefit utilization status, coverage limitations, or non-covered services prior to the appointment.
• Status Updates: Accurately update patient demographic and financial screens to reflect coverage changes (e.g., updating benefit expiration dates, changing the financial plan to Self-Pay).
• Process Improvement: Identify patterns of incomplete/inaccurate front desk data collection and initiate communication with management to support staff training and resource provision.

Required Experience:

• Minimum of 1 year experience in a health care setting
• Ability to collaborate and communicate effectively at all organizational levels
• Proficiency with computers and related software, including Microsoft Office
• Excellent communication skills

Required Education:

• High School diploma or GED

Desired Experience:

• 2 years of experience in an optometry practice
• Knowledge of vision and medical insurance plans
• Experience with ICD-10 and CPT codes
• Electronic claim submission knowledge
• Experience with government and commercial medical and vision insurances such as VSP, UHC, Anthem, Aetna, Bureau of Workers Compensation, Medicare, Medicaid, Medical HMO plans, etc.

Desired Certification(s) or License(s): Certified Medical coder/biller

FUNCTION: Finance

SUB-FUNCTION: Revenue Cycle - Patient Accounting

CAREER BAND: Individual Contributor-Technical

CAREER LEVEL: T2