RCM OPH/RCM Specialist-Vision

Eye Care Partners Career Opportunities•Grand Rapids, MI

About The Position

The RCM Vision Specialist is a subject matter expert in 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 supports accurate and timely claim processing, payment and denial resolution, account documentation, and compliance with company policies and applicable regulations. The role may be performed onsite or remotely. Onsite work takes place in a normal office or clinical environment, and travel to other locations may be necessary. Remote team members must maintain a HIPAA-compliant home office and remain patient-focused while completing required duties. Remote employees may need to work varying shifts, including early mornings or evenings, for meetings, cross-training, or other initiatives. Applicants must reside 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.

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.
Intermediate computer-operation skills and proficiency with Microsoft Excel, Word, PowerPoint, and Outlook.
Experience with practice management software and clearinghouses.
Knowledge of applicable state and federal regulations and a general understanding of HIPAA guidelines.
Detail-oriented, professional, reliable, and able to deliver consistent production 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, functional partners, and teammates.
Ability to learn new technologies and systems, maintain a positive attitude, and flexibly accept work assignments and priorities.
Ability to 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.
For work requiring travel, access to dependable transportation and a driving record meeting company liability-carrier standards.

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 in the practice management system according to standards and productivity measures.
Check the status of unpaid claims within the standard billing cycle.
Review and handle insurance claim denials, exceptions, and exclusions promptly.
Forward medical-record requests to appropriate internal resources.
Correct demographic information as requested by insurance companies.
Read and interpret insurance Explanation of Benefits statements accurately.
Verify insurance payments against contracts for accuracy and compliance and ensure correct reimbursement.
Follow up directly with insurance companies about payment discrepancies.
Use aging reports and workflow statuses to address unpaid or open claims over 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 concerning assigned accounts.
Report identified payment discrepancies and denial trends to the Supervisor as soon as they are identified.
Update the Supervisor weekly on concerns or issues associated with assigned accounts.
Follow company compliance standards, policies, and procedures.
Follow safety policies and procedures while supporting high-quality service and a strong customer-service culture.
Perform other duties necessary or in the organization's best interest.