RCM OPH/RCM Specialist-Vision

Eye Care Partners Career Opportunities•Wyandotte, MI

About The Position

The RCM Vision Specialist is a subject matter expert on revenue cycle management processes and procedures for EyeCare Partners vision practices. The role may cover billing, coding, payment posting, accounts receivable follow-up, insurance claim submission, and patient customer service requests. The position requires residence in one of these states: AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NJ, OH, OK, PA, TX, or VA. Work may be on-site in a normal office or clinical environment, or remote in a HIPAA-compliant home office. Travel to other locations may be necessary for on-site team members, who must have dependable transportation and meet the company’s driving-record standards. Remote team members must be able to work varying shifts, including early mornings and evenings, for meetings, cross-training, or support initiatives.

Requirements

High school diploma or GED.
At least 3 years of medical insurance billing experience.
Experience with CPT and ICD-10 and familiarity with medical terminology.
Knowledge of billing procedures and collection techniques.
Strong written and verbal communication skills, including the ability to communicate effectively in English.
Detail-oriented, professional, and reliable, with consistent production results.
Logical, critical-thinking, and research skills.
Excellent organization, time-management, and prioritization skills.
Customer-focused, with strong listening and communication skills.
Ability to learn new technologies and systems.
Positive attitude and flexibility in accepting work assignments and priorities.
Meet attendance and punctuality expectations.
Management and organizational skills to support leadership of the function.
Ability to follow or provide verbal and written instructions, with sufficient grammar and spelling skills to avoid mistakes or misinterpretations.
Interpersonal skills to support customer service, functional, and teammate needs.
Intermediate computer-operation skills.
Knowledge of state and federal regulations applicable to the position and a general understanding of HIPAA guidelines.
Must reside in AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NJ, OH, OK, PA, TX, or VA.

Nice To Haves

CPC, RHIT, CCS, or CMC coding credentials.
Experience in an ophthalmology practice.
Proficiency with Microsoft Excel, Word, PowerPoint, and Outlook.
Experience with practice management software and clearinghouses.

Responsibilities

Prepare, review, and transmit vision claims using billing software, including electronic, website, and paper claim processing.
Post electronic and manual payments in the practice management system according to standards and productivity measures.
Status unpaid claims within the standard billing cycle timeframe.
Timely review and handle insurance claim denials, exceptions, or exclusions.
Forward medical-record requests to appropriate internal resources.
Address or correct demographic information requested by insurance companies.
Read and accurately interpret insurance Explanation of Benefits (EOBs).
Verify insurance payments for accuracy and contract compliance to ensure correct reimbursement.
Follow up directly with insurance companies about payment discrepancies.
Use aging reports and workflow statuses to address unpaid or open claims aged over 30, 60, 90, and 120-plus days.
Identify and bill secondary or tertiary insurance through Coordination of Benefits.
Document denials associated with patient responsibility and forward them to the collection team.
Research and appeal denied claims.
Answer patient or insurance telephone inquiries pertaining to assigned accounts.
Report identified payment discrepancies or denial trends to the supervisor as soon as possible.
Keep the supervisor informed weekly about concerns or issues associated with accounts.
Comply with company policies and procedures.
Follow safety policies and procedures while supporting high-quality service and a strong customer-service culture.
Perform other duties that may be necessary or in the organization’s best interest.