RCM OPH/RCM Specialist-Vision

Eye Care Partners•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 service requests. The position requires residency in one of the listed states: AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NJ, OH, OK, PA, TX, or VA. The Specialist prepares and submits vision claims, posts payments, follows up on unpaid claims, handles denials and payment discrepancies, and responds to patient and insurer inquiries. The role also involves reviewing insurance benefits and payments, researching and appealing denied claims, coordinating secondary or tertiary billing, and keeping the supervisor informed of account concerns and trends. The position may be performed onsite or remotely in a HIPAA-compliant home office environment. Travel to other locations may be necessary for onsite team members, and work may include varying shifts for meetings, cross-training, or other 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; ability to communicate effectively in English.
Detail-oriented, professional, and reliable, with consistent production results.
Logical, critical-thinking, and research skills.
Strong organization, time-management, and prioritization skills.
Customer-focused listening and communication skills.
Ability to learn new technologies and systems and adapt positively and flexibly to work assignments and priorities.
Meet attendance and tardiness 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.
Proficiency with Microsoft Excel, Word, PowerPoint, and Outlook.
Knowledge of practice management software and clearinghouses.
Knowledge of applicable state and federal regulations and a general understanding of HIPAA guidelines.
For remote work, ability to work in a remote environment while performing required duties and remaining patient-focused.
For onsite team members who travel, access to dependable transportation and a driving record that meets company liability carrier standards.

Nice To Haves

CPC, RHIT, CCS, or CMC coding credentials.
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 established standards and productivity measures.
Status unpaid claims within the standard billing cycle timeframe.
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 contract 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 over 30, 60, 90, and 120-plus days.
Identify and bill secondary or tertiary payers 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 pertaining to assigned accounts.
Report identified payment discrepancies or denial trends for assigned accounts to the Supervisor promptly.
Keep the Supervisor informed weekly of concerns or issues associated with accounts.
Comply with company policies and procedures and follow applicable safety policies while supporting high-quality customer service.
Perform other duties that may be necessary or in the organization’s best interest.