RCM OPH/RCM Specialist-Vision

Eye Care Partners Career Opportunities•Muskegon, MI

4h•Hybrid

About The Position

EyeCare Partners is the nation’s leading provider of clinically integrated eye care, with a national network of over 300 ophthalmologists and 700 optometrists. Based in St. Louis, Missouri, ECP-affiliated practice locations provide care in 18 states and 80 markets, offering services that span the eye care continuum. The mission is to enhance vision, advance eye care, and improve lives. This RCM Specialist- Vision Ophthalmology position is a hybrid role, requiring the candidate to reside in Michigan and be in the office 3 days weekly. As a member of the Revenue Cycle Management Team, the RCM Vision Specialist serves as a subject matter expert regarding RCM processes and procedures necessary for EyeCare Partner Vision Practices. The role encompasses multiple elements including, but not limited to: Billing, Coding, Payment Posting, Accounts Receivable (A/R) follow up, insurance claim submission, and managing customer service requests from patients.

Requirements

High School Diploma or GED
3+ years of Medical Insurance Billing
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
Must reside in Michigan
Access to dependable transportation (for on-site team members who may need to travel)
Driving record must meet company liability carrier standards (for on-site team members who may need to travel)
HIPAA compliant home office environment (for remote team members)
Ability to work in a remote environment while performing required duties and remaining patient focused (for remote team members)

Nice To Haves

CPC, RHIT, CCS, or CMC Coding Credentials
Ophthalmology Practice experience

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.