Revenue Cycle Management Specialist

St Louis Eye Surgery & Laser Center • Saint Louis, MO

396d

About The Position

The Revenue Cycle Management (RCM) Specialist at St. Louis Eye Surgery and Laser Center is a key member of the RCM team, responsible for managing various processes related to billing, coding, payment posting, and accounts receivable. This role requires expertise in RCM procedures to ensure accurate claim submissions, payment processing, and customer service for patients. The specialist will handle insurance claims, address denials, and ensure compliance with company policies while maintaining high standards of customer service.

Requirements

• 3+ years of Medical Insurance Billing experience, preferably in an Ophthalmology Practice.
• Licensure/Certification: CPC, RHIT, CCS, or CMC Coding Credentials preferred.
• 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 with a professional attitude and reliable work ethic.
• Excellent organization, time management, and prioritization skills.
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills.

Nice To Haves

• Experience with practice management software and clearing houses.
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines.

Responsibilities

• Prepare, review, and transmit 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 identify 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.
• 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.

Benefits

• Competitive salary range of $60K - $76K per year.
• Opportunities for professional development and training.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED
• Number of Employees: 1-10 employees