Inside Higher Ed · 3 hours ago
Optometry Claims Coordinator 2
Columbus, OH
Full-time
Hybrid
Entry Level
$17.50/hr - $22.86/hr
1+ years expThe Ohio State University is seeking an Optometry Claims Coordinator 2 to manage claims processing and patient accounts within the College of Optometry. The role involves submitting insurance claims, verifying patient eligibility, and ensuring accurate data management while providing support to patients regarding their accounts.
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Responsibilities
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
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
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
Qualification
Required
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
High School diploma or GED
Preferred
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
Certified Medical coder/biller
Company
Inside Higher Ed
Inside Higher Ed is the online source for news, opinion, and jobs related to higher education.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2022-01-10Acquired
2006-08-31Series Unknown
Leadership Team
Stephanie Shweiki
Director, Foundation Partnerships
Recent News
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