Revenue Cycle Management Specialist

About the position

As a member of the Revenue Cycle Management Team, the RCM Specialist is a subject matter expert regarding RCM processes and procedures necessary for EyeCare Partner Practices. The RCM Specialist may be responsible for multiple elements including, but not limited to: Billing, Coding, Payment Posting, Accounts Receivable (A/R) follow up, insurance claim submission and managing customer services requests from patients.

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 Identifying 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
• Performs other duties that may be necessary or in the best interest of the organization

Requirements

• HS Diploma Required
• 3+ years of Medical Insurance Billing. Ophthalmology Practice 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, professional attitude, reliable
• Consistent production results
• Logical, Critical thinking, and research skills
• Excellent organization, time management, and prioritization skills
• Professional in appearance and actions
• Customer-focused with excellent written, listening and verbal communication skills
• Enjoys learning new technologies and systems
• Exhibits a positive attitude and is flexible in accepting work assignments and priorities
• Meets attendance and tardiness expectations
• Management and organizational skills to support the leadership of this function
• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
• Interpersonal skills to support customer service, functional, and teammate support need
• Able to communicate effectively in English, both verbally and in writing
• Intermediate computer operation
• Proficiency with Microsoft Excel, Word, PowerPoint and Outlook
• Practice management software and clearing houses experience
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Nice-to-haves

• CPC, RHIT, CCS, or CMC Coding Credentials preferred