The Kellogg Eye Center has a purpose of improving lives through curing, treating, and preventing eye disease. Our life's goal is to improve lives around the world by enhancing vision. We have four guiding principles that allow us to operate from a common frame of reference to reach those goals. They are caring, teamwork, integrity, and innovation. We provide both routine and state of the art care to our patients in one of 10 different locations in and around Ann Arbor. Our amazing team of dedicated staff are always looking for talented people who share our passion for touching the lives of our patients and their families by promoting the health of the special sense of vision. We are seeking a Billing/Patient Account Representative Specialist to oversee the insurance referral/authorization process which allows select group of our patients to have the care their need to maximize their vision. The chosen candidate for this position will interact with physicians, technicians, front-end clerical staff, billing staff and patients. This person in this position will be expected to inform and explain insurance coverage and benefits and financial liability to patients.
- Initiate all new and refit PROSE treatment insurance inquiries
- Review clinic schedules in order to verify benefits and obtain authorizations/referrals that are required for primarily for PROSE, Contact Lens, and Low Vision and then other clinics as necessary
- Counsel patients regarding insurance coverage(i.e co-pays, deductibles, out of pocket expenses, non-covered expenses, etc)
- Discuss with patient the difference between medical and vision under their policy
- Coordinate MD and OD medical necessity letters, insurance packets and other supporting documentation
- Follow-up with all pre-authorizations/ pre-determination requests Appeal all pre-authorizations and predeterminations denials
- Set-up Peer to Peer discussions when required
- Discuss financial assistance application with patient when necessary.
- Assure all necessary documents accompany financial assistance applications and prepare for administrative review
- Handle incoming phone calls and in-office patients regarding patient statements, referrals, authorizations, collection of outstanding balances, co-pays, deductibles, and non-covered services.
- Meet with all approved PROSE treatment candidates after their initial consult
- Assure all patients have signed the necessary financial waiver
- Maintain and document all insurance and patient communications
- Maintain PROSE financial review in PROSE file
- Review billing information monthly to assure charges are correctly entered and verify charges have been sent to appropriate KMS billing specialist
- Work edits in Workques
- Duties are subject to change.
- High School diploma
- Two or more years of experience working with patients and/or medical insurance plans.
- Excellent verbal and written communications skills
- Excellent customer service skills and attendance history.
- Ability to problem solve and multi-task effectively.
- Candidate must be a team player as well as be able to work independently.
- A college degree or an equivalent combination of education and experience.
- Have working knowledge about MI-chart, E-referral, and Web-Denis
- General computer literacy including Microsoft Word and Excel
- Familiar with CPT, HCPC and ICD-10 codes, modifiers
- Experience in Ophthalmology and/or Optometry billing
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. This job may be removed from posting boards and filled anytime after the minimum posting period has ended.
U-M EEO/AA Statement
The University of Michigan is an equal opportunity/affirmative action employer.