Senior RCM Specialist

American Vision Partners; Phoenix (AZ); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical and dental insurance

Eye care discounts

Child care assistance

Pet insurance

Continuing education funds

401(k)

Paid holidays

PTO

Sick Time

Growth opportunities

Job summary

American Vision Partners is seeking an experienced Revenue Cycle Specialist to oversee the full billing, collections, and compliance workflow at our Phoenix corporate office. This role concentrates on maximizing revenue while maintaining strict HIPAA standards.

The ideal candidate has 7 years of medical billing experience, preferably in ophthalmology, with solid knowledge of CMS guidelines and payer coding policies. Candidates must be on-site in Phoenix and able to collaborate across departments.

Qualifications

• 7 years medical billing experience.
• Ophthalmology background desired.
• Active knowledge of CMS guidelines, contracted insurance guidelines and coding policies.
• Demonstrated computer literacy.
• Well-organized with attention to detail.
• Ability to read and understand oral and written instructions.
• Excellent math skills.
• Ability to establish and maintain effective working relationships with team members, clinic staff, payers and patients.
• Professional customer service skills.
• Have a desire and dedication to work with self-discipline.
• Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations.
• Prior experience working full cycle revenue in the healthcare setting.

Responsibilities

• Follows-up with patients and payers and ensures outstanding balances are paid accurately.
• Makes calls to and takes calls from patients, discussing their account in detail.
• Contacts insurance plans to determine eligibility and obtain coverage and benefit information.
• Contacts insurance plans to obtain prior authorization for services.
• Accurately reviews outstanding insurance and patient credit balances to determine appropriate party to refund.
• Responsibilities will include accurately posting payments, adjustments and refunds as necessary.
• Responsible for reviewing and gathering appropriate documentation for payor requested Risk Adjustment Audits. Coordinates on site chart pulls as appropriate
• Reviews and appeals unpaid and denied claims, includes analysis of coding that Analyze daily financial exceptions from the charge capture audit reports to determine areas of leakage and partner with information technology and clinical service lines to rectify charge capture issues by assisting service lines to improve their ability to capture compliant charges
• Manages the processing and submission of provider enrollment applications with the payers in a timely and accurate manner
• Scanning all incoming mail and distributing according to department policy
• Meets or exceeds productivity standards in the completion of daily assignments and accurate production
• Deposits checks and other payments confirming that all necessary documents are properly authorized, are in proper form, and are within authorized limits
• Develop and maintain a current in-depth knowledge of all Banking transactions to include EFT, ERA, Paper, Check and all document handling and management
• Performs all other assigned duties

Skills

Medical billing

Ophthalmology background

CMS guidelines

Attention to detail

Communication with payers

Customer service

HIPAA compliance

Job description

At American Vision Partners (AVP), we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center, Retinal Consultants of Arizona, M&M Eye Institute, Abrams Eye Institute, Southwest Eye Institute, Aiello Eye Institute, Moretsky Cassidy Vision Correction, Wellish Vision Institute, West Texas Eye Associates and Vantage Eye Center. We are focused on building the nation’s largest and most comprehensive eye care practices and currently operate more than 100 eye care centers in Arizona, New Mexico, Nevada, California and Texas – including 25 ambulatory surgical centers.

At AVP we value teamwork, providing exceptional experiences, continuous improvement, financial strength, and hard work. We are committed to providing best-in-class patient care, pioneering research and technology, and most importantly, rewarding and recognizing our employees!

Overview

This position is responsible for the entire revenue cycle process, ensuring efficient billing, collections, and compliance with regulations. This role plays a crucial part in maximizing revenue and minimizing losses for the organization within the Revenue Cycle Management department.

This role is based exclusively at our Phoenix Corporate Office in the Biltmore area and requires daily onsite attendance - This is not a remote or hybrid position.

Responsibilities

• Follows-up with patients and payers and ensures outstanding balances are paid accurately
• Makes calls to and takes calls from patients, discussing their account in detail
• Contacts insurance plans to determine eligibility and obtain coverage and benefit information
• Contacts insurance plans to obtain prior authorization for services
• Accurately reviews outstanding insurance and patient credit balances to determine appropriate party to refund
• Responsibilities will include accurately posting payments, adjustments and refunds as necessary
• Responsible for reviewing and gathering appropriate documentation for payor requested Risk Adjustment Audits. Coordinates on site chart pulls as appropriate
• Reviews and appeals unpaid and denied claims, includes analysis of coding that Analyze daily financial exceptions from the charge capture audit reports to determine areas of leakage and partner with information technology and clinical service lines to rectify charge capture issues by assisting service lines to improve their ability to capture compliant charges
• Manages the processing and submission of provider enrollment applications with the payers in a timely and accurate manner
• Scanning all incoming mail and distributing according to department policy
• Meets or exceeds productivity standards in the completion of daily assignments and accurate production
• Deposits checks and other payments confirming that all necessary documents are properly authorized, are in proper form, and are within authorized limits
• Develop and maintain a current in-depth knowledge of all Banking transactions to include EFT, ERA, Paper, Check and all document handling and management
• Performs all other assigned duties

Qualifications

• 7 years medical billing experience
• Ophthalmology background desired
• Active knowledge of CMS guidelines, contracted insurance guidelines and coding policies
• Demonstrated computer literacy
• Well-organized with attention to detail
• Ability to read and understand oral and written instructions
• Excellent math skills
• Ability to establish and maintain effective working relationship with team members, clinic staff, payers and patients
• Professional customer service skills
• Have a desire and dedication to work with self-discipline
• Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations
• Prior experience working full cycle revenue in the healthcare setting

Benefits & Perks

Your health, happiness and your future matters! At AVP, we offer everything from medical and dental insurance, significant eye care discounts, child care assistance, pet insurance, continuing education funds, 401(k), paid holidays, PTO, Sick Time, opportunity for growth, and much more!