EyeCare Partners is the nation’s leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visit www.eyecare-partners.com.
SUMMARY
This position is responsible for the successful implementation and support of applications to include entering and maintaining billing plans and funding, systems and processes to support the company's billing department, troubleshooting all system application issues that arise from end users, and support medical/retail store operations.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Contract Configuration knowledge
- Manually calculate claim allowable if applicable
- Analyze multiple Client/Payer Contracts (Commercial, Managed Medicare/Medicaid, straight Governmental, Workers Comp.)
- Analyze all Payer Policies
- Validate accuracy of all payer contracts including language, rates, and are loaded and are being priced accurately.
- Cross reference claims against fee schedules, contracted rates, payer policies, etc. in order to validate the system and claims are being paid based on contractual obligations. if a claims are contractually underpaid
- Requires a thorough understanding of the applications and related business processes that are assigned
- Fully understands the purpose of each solution as it relates to the businesses strategic direction.
- Requires an understanding of the features of each system, including their core responsibilities and how they utilize each solution for their specific job requirements.
- Requires an understanding of insurance carriers to support internal workers to resolve issues during the day.
- Requires an in depth knowledge of current requirements of the insurance carriers for routine and medical standards.
- Support external resources through the various companies from plan designs, insurance inquiries, and billing support issues.
Application configuration, testing and support.
- Requires an in-depth knowledge of how to configure each system's features to support the business requirements.
- Support internal resources for both new and existing systems to resolve issues arising during production use.
- The ability to “train the trainers” and train individuals in unique circumstances.
- Requires an understanding of 837’s and 835’s
QUALIFICATIONS
A high school diploma or GED. An Associate’s degree is preferred, with a focus in healthcare administration, business, or a related field from an accredited college or university
EDUCATION AND/OR EXPERIENCE
- Experience interpreting contracts that includes rates, amendments, terminology, and the insurance industry process and procedures
- Strong decision making and problem-solving skills
- Familiarity with the CPT’s, HCPCs, ICD-10, and CMS 1500 claim form
- Strong analytical and mathematical skills
- Prior experience with healthcare accounts receivables
- Understanding of managed care contracts
- Proficiency in MS Word, Excel and PowerPoint
LICENSES AND CREDENTIALS
- Minimum Required: None
SYSTEMS AND TECHNOLOGY
- Proficient in Microsoft Excel, Word, PowerPoint, Outlook
NOTE: Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time.