RCM OPH/RCM Specialist

Eye Care Partners•Southgate, MI

36d•Onsite

About The Position

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

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

Nice To Haves

Ophthalmology Practice preferred.
CPC, RHIT, CCS, or CMC Coding Credentials preferred

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.