Billing Specialist Assistant , Optometry Clinic

Billing Specialist Assistant (4722C), Optometry Clinic - 84379

Reporting to the Billing and Collections Manager, the billing specialist will provide patient, third party, government, physician billing and collections activities.

The First Review Date for this job is: 03/03/2026.

• Prepare and submit insurance claims to medical and vision insurance providers as well as produce patient statements.
• Assist in verifying completeness and accuracy of charge captured information by reviewing daily schedule and charts for appropriateness and completeness of charges, PQRS and meaningful use data.
• Using the Practice Management System, generate and scrub claims resolving issues in a timely manner.
• Generate claims batches and transmit to carrier electronically.
• Review claims transaction reports to capture detail related to denials.
• Identify and make corrections to denials, alerting Clinic Administration, IT of chronic denials due to coding errors.
• Resolve issues related to rejected claims and rebill claims.
• Review and resolve any claims that have been on HOLD status to resolve payment or billing issues.
• Send statements to patients.
• Process EOBs and monitor claim and patient payments.
• Post payments to visits in the electronic medical records system upon receipt of payment for claims.
• Process claim balances to secondary payors or patient balances as required.
• Correct and resubmit denied claims as required.
• Monitor unpaid claims and follow up with insurance carriers in a timely manner to insure payment.
• Monitor delinquent patient accounts and convert to collections as required.
• Generate regular reports on the status and completeness of insurance and patient responsible balances, payments, adjustments and write offs.
• Conduct follow-up on accounts and evaluate appropriate follow-up action in a stratified manner by modified account balance as assigned through monthly ad-hoc reports to achieve weekly and monthly goals.
• Comply with the rules and regulations of different payers such as Medicare, Medi‑Cal, HMOs, commercial payers, Workers Compensation, and government agencies.
• Interpret and enter detailed online notes to understand past activity and provide an audit trail for future follow-up.
• Communicate effectively with payers, patients, clinic chiefs, and outside billing agents.
• Perform all follow-up necessary to track missing payments and utilize various systems such as Compulink, Epic, Microsoft Outlook, government, and non‑government websites for detailed follow-up.
• Coordinate and collaborate with supervisor and/or Manager to resolve and problem solve billing issues.
• Review non‑payment and/or incorrect payment(s) for possible appeal.
• Request restoral of contractual allowances or adjustments to initiate appeals as warranted.
• Prepare appeal letters to payers requesting additional payment and retrieve necessary information to support appeal letter.
• Perform proactive follow-ups for all appeals submitted.
• Analyze Explanation of Benefits (EOB) for accurate posting of rejections, adjustments, and any other posting requirements and notify manager of refunds, adjustments, and transfers as needed.
• Secure guarantor/patient demographic and/or insurance information as required.
• Respond and resolve inquiries that may include billing policies and procedures, pricing, and coding.
• Resubmit bills to payers in a timely manner and in accordance with department and payer requirements.
• Process denials as required in accordance with departmental procedures.
• Retrieve reports and/or additional information from various sources.
• Prepare appeals on denial(s) as warranted and initiate write‑off request(s) if appropriate.
• Notate activity performed for denial(s) processed and maintain records of all processed denial/appeal(s) for tracking and reporting purposes.
• Assist in credentialing/paneling faculty with insurance carriers.
• Maintain accurate rosters of providers per insurance carriers as assigned.
• Communicate roster status as required to insure patients are scheduled with credentialed providers.
• Train peers and/or clinic colleagues (faculty, staff, students) as necessary.
• Monitor billing email and assist with patient correspondence in a…