Medical Insurance Collections Associate

* This position is on-site in the Willow Lawn area of Richmond*

You are responsible for filing insurance claims, managing patient accounts, and answering account status inquiries on optometry and ophthalmology patients. You collect and enter claim information, follow up on unpaid and rejected claims in a timely manner, and may assist with posting insurance and patient payments as needed. You are also held accountable for documenting all customer interactions in the appropriate computer system.

The representative reports directly to the Revenue Cycle Manager of Collections.

• Enter information necessary for insurance claims such as patient insurance , diagnosis and treatment codes and modifiers and provider information. Ensure that claim information is concise, complete, and accurate.
• Submit insurance claims to clearinghouses or individual insurance companies electronically or via paper CMS‑1500 form.
• Answer patient questions on responsible balances, copays, deductibles, write‑offs, etc.; resolve patient complaints or explain why certain services are not covered while demonstrating positive customer relationship skills with all telephone encounters.
• Follow up with insurance companies on unpaid or rejected claims. Resolve issues and resubmit claims.
• Prepare appeal letters to insurance carriers when not in agreement with claim denial. Collect necessary information to accompany appeal.
• Follow up on past‑due patient balances and provide necessary information to collection agencies for delinquent accounts.
• May perform “soft” collections for patient past‑due accounts, including contacting and notifying patients via phone or mail.
• Prepare and submit secondary claims upon processing by primary insurer.
• Post insurance and patient payments using medical claim billing software as needed.
• Understand managed care authorizations and limits to coverage such as number of visits.
• Verify patient benefits eligibility and coverage.
• Meet outlined AVP benchmarks and/or quality indicators as monitored through audits or recordings.
• Meet the expectations of our internal and external customers in providing excellent service.
• Support organizational changes. Demonstrate flexibility in providing coverage and/or availability for the insurance department via scheduling adjustments for unexpected absences, events, or work volume variances.
• Process patient and insurance carrier refunds.
• Other duties and special projects assigned by management.
• Follow HIPAA guidelines in handling patient information.

• High School Diploma or equivalent required.
• Computer skills that include a combination of experience in a Windows Operating System, e‑mail, and data entry.
• Prior experience with medical billing software is preferred but not required.
• Three to five years in insurance billing required.
• Excellent judgment, dependability, and conscientiousness.
• Demonstrated high ethical standards and integrity.
• Attention to detail.
• Accuracy and thoroughness; monitor own work to ensure quality.
• Customer and patient service orientation: prompt response to patient needs and ability to manage difficult or emotional customer situations with tact, empathy and diplomacy.
• Ability to work cooperatively in group situations; offer assistance and support to coworkers, actively resolve conflicts, inspire trust of others, and treat patients and coworkers with respect.
• Patient‑centered care focused, and a team player.
• Handles multiple tasks effectively and efficiently and exhibits commitment to effective problem‑solving techniques when issues arise.
• Continuously act to maintain a safe, clean, healthy, and fun work environment consistent with AVP’s mission and vision.
• Arrive on time, ready to work, and demonstrate minimal absenteeism.
• Demonstrate effective problem‑solving skills.
• Knowledgeable of Medicare and Medicaid billing and reimbursement concepts and principles.
• Willingness to submit to a background check.

We’ve got you covered in more ways than one! As a full‑time employee, you receive medical, dental, vision, a 401(k) plan, long‑term disability, and life insurance. Pay is determined based on…