RCM OPH/RCM Specialist

EyeCare Partners LLC; Wyandotte (MI); On-site; USD 52,000 - 78,000; Full time

Job summary

EyeCare Partners LLC is seeking a Revenue Cycle Management (RCM) Vision Ophthalmology Specialist to join the team. The specialist will handle billing, coding, payment posting, A/R follow-up, and insurance claim submission across EyeCare Partner Vision Practices.

As a subject matter expert, you will interpret EOBs, verify insurance payments, address denials, and communicate with patients and insurers to resolve discrepancies.

Qualifications

• 3+ years of Medical Insurance Billing experience, ophthalmology preferred.
• Familiarity with CPT and ICD-10.
• Knowledge of billing procedures and collection techniques.
• Experience with insurance claim submission and denials management.

Responsibilities

• Prepare, review, and transmit vision claims using billing software.
• Post payments into the practice management system.
• Status unpaid claims within standard billing cycle timeframe.
• Timely review/handling of insurance claim denials, exceptions, or exclusions.
• Forwards requests for medical records to appropriate internal resources.
• Addresses/corrects demographic information requested by insurance company.
• Ability to read and accurately interpret insurance Explanation of Benefits (EOB's).
• Verifying insurance payments for accuracy/compliance based on contracts to ensure correct reimbursement.
• Following up directly with insurance companies regarding payment discrepancies.
• Utilizing aging reports and workflow statuses to address any unpaid or open claims over 30, 60, 90, and 120 plus.

Skills

Communication skills

Attention to detail

Interpersonal skills

Medical terminology

Customer focus

Education

High School Diploma or GED

Medical coding credentials (CPC/RHIT/CCS/CMC)

Tools

Excel

Word

PowerPoint

Outlook

Job description

EyeCare Partners is the nation's leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visitwww.eyecare-partners.com.

Job Title:

RCM Specialist- Vision Ophthalmology

Must reside in the following states

AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NJ, OH, OK, PA, TX, VA

Job Summary

As a member of the Revenue Cycle Management Team, the RCM Vision Specialist is a subject matter expert regarding RCM processes and procedures necessary for EyeCare Partner Vision Practices.

The RCM Specialist may be responsible for multiple elements including, but not limited to: Billing, Coding, Payment Posting, Accounts Receivable (A/R) follow up, insurance claim submission and managing customer services requests from patients.

Duties and Responsibilities

• Prepare, review, and transmit vision claims using billing software including electronic, website submission, and paper claim processing
• Post payments both electronically and manually into the practice management system according to set standards and productivity measures.
• Status unpaid claims within standard billing cycle timeframe
• Timely review/handling of insurance claim denials, exceptions, or exclusions
• Forwards requests for medical records to appropriate internal resources
• Addresses/corrects demographic information requested by insurance company
• Ability to read and accurately interpret insurance Explanation of Benefits (EOB's)
• Verifying insurance payments for accuracy/compliance based on contracts to ensure correct reimbursement is received
• Following up directly with insurance companies regarding payment discrepancies
• Utilizing aging reports and workflow statuses to address any unpaid or open claims over 30, 60, 90, and 120 plus
• Coordination of Benefits (COB) – Ability to Identifying and bill secondary or tertiary
• Documenting denials associated with patient responsibility to forward to the collection team
• Ability to research and appeal denied claims
• Answering all patient or insurance telephone inquiries pertaining to assigned accounts
• Report payment discrepancies or denial trends identified to Supervisor as soon as they are identified for assigned accounts
• Keep supervisor abreast weekly of any concerns or issues associated with accounts
• Adhering to company standards of compliance with policies and procedures
• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.
• Performs other duties that may be necessary or in the best interest of the organization.

Education, Licensure & Certification Requirements

High School Diploma or GED

CPC, RHIT, CCS, or CMC Coding Credentials preferred

Experience Requirements

3+ years of Medical Insurance Billing. Ophthalmology Practice preferred.

Knowledge, Skills and Abilities Requirements

• Experience with CPT and ICD-10; Familiarity with medical terminology
• Knowledge of billing procedures and collection techniques
• Strong written and verbal communication skills
• Detail oriented, professional attitude, reliable Consistent production results
• Logical, Critical thinking, and research skills
• Excellent organization, time management, and prioritization skills
• Professional in appearance and actions
• Customer-focused with excellent written, listening and verbal communication skills
• Enjoys learning new technologies and systems
• Exhibits a positive attitude and is flexible in accepting work assignments and priorities
• Meets attendance and tardiness expectations
• Management and organizational skills to support the leadership of this function
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
• Interpersonal skills to support customer service, functional, and teammate support need
• Able to communicate effectively in English, both verbally and in writing Intermediate computer operation Proficiency with Microsoft Excel, Word, PowerPoint and Outlook Practice management software and clearing houses experience
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

For on-site team members, work takes place in a normal office/clinical environment. Travel to other locations may be necessary to fulfill the essential duties and responsibilities of the job. Thus, those needing to travel for work must have access to dependable transportation, and their driving record must meet company liability carrier standards.

For remote team members, HIPAA compliant home office environment. Ability to work in a remote environment while performing required duties and remaining patient focused. Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives.

EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Please do not contact the office directly – only resumes submitted through this website will be considered

NOTE: Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time.