RCM OPH/RCM Specialist-Vision

Eye Care Partners•Grand Rapids, 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 include billing, coding, payment posting, accounts receivable follow-up, insurance claim submission, and responding to patient service requests. The position may be performed onsite or remotely. Onsite work takes place in a standard office or clinical environment, and travel to other locations may be necessary. Remote team members must maintain a HIPAA-compliant home office environment and remain patient-focused while performing required duties. Team members may work varying shifts, including early mornings or evenings, to attend meetings, cross-train, or support other initiatives. Applicants must reside in one of the following states: AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NJ, OH, OK, PA, TX, or VA.

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, reliable, and able to produce consistent results.
Logical, critical-thinking, and research skills.
Strong organization, time-management, and prioritization skills.
Customer-focused listening and communication skills, with interpersonal skills to support customers, functions, and teammates.
Ability to learn new technologies and systems; intermediate computer skills.
Proficiency with Microsoft Excel, Word, PowerPoint, and Outlook.
Ability to use practice management software and clearinghouses.
Knowledge of applicable state and federal regulations and a general understanding of HIPAA guidelines.
Ability to follow or provide verbal and written instructions, with sufficient grammar and spelling skills to avoid mistakes or misinterpretations.
Positive attitude and flexibility in accepting work assignments and changing priorities.
Meet attendance and punctuality expectations.
Management and organizational skills to support leadership of the function.
For remote work, ability to work in a HIPAA-compliant home office and remain patient-focused while performing required duties.
For roles requiring travel, dependable transportation and a driving record that meets company liability carrier standards.
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 credential.
Experience in an ophthalmology practice.

Responsibilities

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