AR Specialist

Company Overview

Join Houston Retina Associates

At Houston Retina Associates, we’re more than a leading ophthalmology practice—we’re a team dedicated to preserving and restoring vision for our patients. Specializing in advanced care for retinal conditions like macular degeneration, diabetic retinopathy, and retinal detachment, we combine cutting-edge technology with compassionate, personalized treatment. Our culture is built on collaboration, innovation, and continuous learning. We value every team member’s contribution and provide opportunities for professional growth in a supportive environment. With multiple locations across the greater Houston area, we’re proud to serve our community and make a meaningful impact every day. If you’re passionate about excellence in patient care and want to be part of a team that truly makes a difference, we invite you to join our team!

Houston Retina Associates is affiliated with EyeSouth Partners' premier network of medical and surgical specialty eye care services.

Position Summary

The A/R Specialist is responsible for the company’s third-party medical claims processing and assisting patients and office staff with questions on insurance claims, authorizations, statements, and other billing issues. This position will prepare, submit and follow-up on medical claims for Managed Care Organization (MCO), Medicaid, Medicare, Other Federal, Private Insurance, and Workers Compensation.

This is a Hybrid Position, the A/R Specialist will be expected to work in person at our Houston Office one day a week.

**Applicants who live and plan to work from the following states will not be considered at this time: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Idaho, Montana, Maryland, Massachusetts, Michigan, Nevada, New Mexico, Oregon, New Hampshire, New Jersey, Utah, New York, Rhode Island, Washington, and Wyoming. Thank you for your interest.

Responsibilities

• Files and processes primary and secondary third-party medical
• Verifies all the information for claims processing is complete and
• Contacts the appropriate person to obtain missing or unclear billing
• Follows-up by website and/or telephone on all unpaid and denied claims to determine next course of action, which may require rebilling missing claims, denied claims or sending additional information on pending claims
• Sends appeal letters to insurance
• Obtains authorizations when needed.
• Identifies and corrects charge entry/ billing
• Provides proper documentation to insurance companies.
• Handles insurance company questions, complaints, and/or responds to and interacts with patients concerning all aspects of billing through phone, e-mail, or regular mail in a prompt and courteous
• Documents all actions and maintains permanent records of patient
• Assists with answering phones, screening calls and following-up on
• Works with management on patient billing and insurance
• Processes refunds to patients and insurance
• Works with outside programs (i.e., co-pay assistance) to ensure proper
• Communicates with front office staff to attempt to collect any outstanding patient
• Contributes to the team effort by completing other tasks and projects as needed

Qualifications

• Minimum of two (2) years Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system
• CPC, CPOC, COC certifications a plus
• Six months of previous customer service experience preferred
• Prior experience with an electronic medical record system required (EHR/EMR)
• Working knowledge of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; and strong knowledge of Federal payer regulations
• Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes
• Ability to handle sensitive and confidential information in a professional manner
• Maintains knowledge of coordination of benefits requirements and processes
• Demonstrated success working in a team environment focused on meeting organization goals and objectives is necessary
• Self-motivated with strong organizational skills and superior attention to detail
• Ability to review documents for accuracy and reasonability
• Ability to work well under pressure
• Ability to multi-task, set priorities and follow through without direct supervision
• Effectively communicate with physicians, patients, insurers, colleagues, and staff
• Intermediate computer skills including Microsoft Office; especially Word, Excel, and PowerPoint
• Knowledge of policies and procedures to accurately answer questions from internal and external customers
• Detail oriented and tolerant of frequent interruptions and distractions from patients and staff
• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external
• Exercises sound judgment in responding to inquiries; understands when to route inquiries to next level
• Team player that develops strong collaborative working relationships with internal partners and can effectively engage and ability to build consensus among cross-functional teams

Company Benefits

We offer a competitive benefits package to our employees:

• Medical
• Dental
• Vision
• 401k w/ Match
• HSA/FSA
• Telemedicine
• Generous PTO Package

We also offer the following benefits for FREE:

• Employee Discounts and Perks
• Employee Assistance Program
• Group Life/AD&D
• Short Term Disability Insurance
• Long Term Disability Insurance

EyeSouth Partners is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.