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Role Description

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
• Managing customer service requests from patients

Duties and 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 to Supervisor as soon as they are identified for assigned accounts
• 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

Qualifications

• High School Diploma or GED
• CPC, RHIT, CCS, or CMC Coding Credentials preferred

Requirements

• 3+ years of Medical Insurance Billing
• Ophthalmology Practice preferred

Knowledge, Skills and Abilities Requirements

• 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

Location/Work Environment

• For on-site team members, work takes place in a normal office/clinical environment. Travel to other locations may be necessary to fulfill the essential duties and responsibilities of the job.
• For remote team members, HIPAA compliant home office environment. Ability to work in a remote environment while performing required duties and remaining patient focused.
• Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives.