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EyeCare Partners · 2 days ago

RCM OPH/RCM Specialist

Southgate, MI

Full-time

Onsite

Mid Level

3+ years exp

EyeCare Partners is the nation’s leading provider of clinically integrated eye care, with a mission to enhance vision and improve lives. The RCM Specialist plays a crucial role in the Revenue Cycle Management Team, handling billing, coding, payment posting, and managing insurance claims to ensure efficient revenue processes for the organization.

Hospital & Health Care

Responsibilities

Prepare, review, and transmit vision 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 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

Qualification

Medical Insurance BillingCPTICD-10Billing ProceduresPractice Management SoftwareCPCRHITCCSCMCCustomer ServiceCommunication SkillsDetail OrientedTime ManagementInterpersonal Skills

Required

Must reside in/near Southgate, MI

High School Diploma or GED

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

Preferred

CPC, RHIT, CCS, or CMC Coding Credentials preferred

Ophthalmology Practice preferred

Company

EyeCare Partners

At EyeCare Partners, we are on a mission to reinvent eye care by creating a network of optometry and ophthalmology practices that bring together a wealth of expertise, resources and knowledge.

Founded in 2015

St. Louis, Missouri, US

5001-10000 employees