Credentialing and Outreach Specialist

College of Optometry

This position works directly with the Patient Account Staff and Manager to maximize center revenue and control account aging. In addition to basic billing functions such as submitting claims and reconciling accounts, this role is expected to perform high level claims resolution, analyze claim data, and poses an upper-level understanding of insurance benefits.

• Perform high level claim processing functions such as reimbursement discrepancies, specialty authorizations, voided/returned services and materials, reconciling refunds, and verifying payments containing lab charge backs
• Submit electronic claim batches through the billing software, print and mail paper claims, and input data electronically into insurance portals as needed
• Confirm successful transmission of electronic claims via clearinghouse EDI reports
• Review and analyze billing edits, errors, unpaid claims etc. and resolve within scope of authority
• Compile claim submission data to generate production summaries and identify areas of opportunity
• Research and refile denied/unpaid claims based on the specific payer guidelines for appeals
• Reconcile patient ledgers to insurance remittance (EOB/EOP) by posting payments and adjustments
• Balance daily payment reports against checks/wires to prepare for deposit
• Generate patient billing statements for approval/release
• Assist the Patient Account Manager in collection activities related to delinquent accounts
• Prepare clinic schedules by verifying patient eligibility and generating authorizations
• Communicate effectively with clinic staff and faculty at all CEC sites: act as a resource for questions related to insurance, patient accounts, authorizations, refunds, etc
• Access & review updates to the insurance provider manuals to ensure accurate billing procedures and adhere to all federal, state, and payer regulations
• Understand HIPAA requirements and assist in ensuring the department adheres to these standards
• Complete remittance review audits as requested and communicate results to the billing staff
• Communicate with insurance payers and patients via telephone, fax, and/or in writing
• Attend billing and insurance related meetings and seminars as requested
• Perform other billing related duties as assigned

Applicants must be authorized to work in the United States. The University will not sponsor applicants for this position for employment visas.

40 hours/week. Monday thru Friday

Bachelor's degree or an equivalent combination of education and experience and at least 2 years of experience from which comparable knowledge and skills can be acquired is necessary

• One-year experience with credentialing
• Knowledge of HIPAA privacy and compliance standards is required
• Superior organizational skills and strong oral and written communication skills
• Ability to work independently and to prioritize and manage multiple tasks and produce results
• Must maintain confidentiality of highly confidential information regarding sensitive personal/professional information

Salary Range: $19.00 - $23.00 per hour
Grade: GGS-007
University Title: Senior Office Support Assistant
Internal applicants can determine their University title by accessing the Talent Profile tile in myHR.

• Application materials include a cover letter and resume. Finalists will be asked to provide references at a later date.
• Applicants must combine all application materials into one PDF or Microsoft Word document and upload as a resume attachment to the UMSL Careers: https://www.umsl.edu/services/hrs/careers/index.html
• Limit document name to 50 characters. Maximum size limit is 11MB. Do not include special characters (e.g., /, &, %, etc.). For questions about the application process, please email employment@umsl.edu. If you are experiencing technical problems, please email umpshrsupport@umsystem.edu.

This position is eligible for University benefits. As part of your total compensation, the University offers a comprehensive benefits package, including medical, dental and vision plans, retirement, paid time off, short- and long-term disability, paid parental leave, paid caregiver leave, and educational fee discounts for all four UM System campuses. For additional information on University benefits, please visit the Faculty & Staff Benefits website at https://www.umsystem.edu/totalrewards/benefits.

Equal Employment Opportunity

The University of Missouri is an Equal Opportunity Employer.

To request ADA accommodations, please email the Office of Human Resources at umslhr@umsl.edu.