RCM Support Services Specialist

US Eye•Elizabeth City, NC

5d•Hybrid

About The Position

The RCM Support Services Specialist is responsible for ensuring a seamless and transparent financial experience for patients while maintaining accuracy throughout the revenue cycle. This role supports the billing and clinical teams by addressing patient billing inquiries, reviewing and updating claims, identifying charge posting or payment errors, reviewing authorizations, and performing financial clearance for upcoming procedures. The specialist also provides real-time cost estimates for office visits, diagnostic testing, and surgeries. The ideal candidate will have a strong understanding of ophthalmology and retina billing, payer authorization requirements, and a dedication to patient-centered financial communication.

Requirements

Expertise in insurance verification, authorization management, financial clearance and AR billing functions.
Strong analytical skills for identifying and resolving charge posting, payment errors and payer denials.
Excellent written and verbal communication with a compassionate, patient-centered approach.
Proficiency with EHR and billing platforms (e.g., NextGen and Intellichart Pro, etc).
Exceptional attention to detail, organization, and multitasking ability in a fast-paced environment.
High school diploma or GED required; associate degree or certification in medical billing preferred.
Minimum 2–3 years of experience in ophthalmology or retina billing, authorizations, or RCM support.
Strong understanding of CPT/ICD-10 coding, payer policies, and modifier use specific to ophthalmology and retina services (e.g., injections, bilateral procedures, global periods).

Responsibilities

Respond promptly and professionally to patient billing and statement inquiries while on-site or by phone.
Clearly explain insurance benefits, copayments, deductibles, and out-of-pocket costs related to ophthalmology and retina services (e.g., OCT, fluorescein angiography, intravitreal injections, cataract or retina surgeries).
Assist patients with payment options, including financial assistance options, and understand their financial responsibilities.
Escalate/triage to Financial Clearance Teams when applicable.
Coordinate with the appropriate RCM Support teams for resolution of any billing issues & monitor the timely completion of those requests.
Research, update, and correct claim data to ensure timely and accurate submission.
Identify and resolve charge posting or payment errors, including misapplied payments, incorrect adjustments, and missing transactions.
Collaborate with billing and coding teams to correct denials or rejections and prevent recurrence.
Escalate/triage to Accounts Receivables (A/R), Charge Posting, and Payment Posting Teams when applicable.
Review patient accounts prior to visits, procedures, or surgeries to confirm all authorizations and referrals are valid and current.
Verify insurance eligibility and benefits for current appointments and provide patients with detailed information pertaining to their health plan design.
Coordinate with clinical and scheduling teams to ensure all services are authorized and financially cleared before the date of service.
Escalate missing or delayed authorizations promptly to minimize denials and scheduling disruptions.
Generate accurate, real-time (“on-the-fly”) cost estimates for office visits, diagnostics, injections, and surgeries using payer information and practice fee schedules.
Triage complex or multi-procedure estimate requests for financial counseling review and patient communication.
Participation in a working session with other RCM team members to discuss opportunities for improvement.
Work closely with RCM senior leadership on addressing issues and implementing agreed-upon solutions in a timely manner.
Document all patient and payer communications accurately in the EHR/billing system.
Collaborate across teams—scheduling, authorizations, billing, and clinical—to ensure accurate financial data and a smooth patient experience.
Escalate complex financial or insurance issues to RCM leadership for resolution.
During non-peak times, providing additional RCM Support within other departments (i.e., patient assistance – enrollments, shipments, and replacement drugs), A/R Support (Claim status for unresponded to claims, review and outreach to patients with large outstanding balances and accounts in pre-list status, targeted denial management).