RCM OPH​/RCM Specialist

Eye Care Partners is the nation’s leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP‑affiliated practice locations provide care in 18 states and 80 markets, offering services that span the eye care continuum.

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RCM Specialist

Must reside in/near Southgate, MI. Onsite work only – NOT Remote.

As a member of the Revenue Cycle Management Team, the RCM Specialist acts as a subject matter expert on RCM processes and procedures necessary for Eye Care Partners’ practices. The role may involve billing, coding, payment posting, accounts receivable follow‑up, insurance claim submission, and handling patient service requests.

• Prepare, review, and transmit vision claims using billing software, including electronic, website submission, and paper claim processing.
• Post payments electronically and manually into the practice management system per standards.
• Status unpaid claims within standard billing cycle time frames.
• Review and handle insurance claim denials, exceptions, or exclusions in a timely manner.
• Forward requests for medical records to appropriate internal resources.
• Correct demographic information requested by insurance companies.
• Read and interpret insurance Explanation of Benefits (EOBs) accurately.
• Verify insurance payments for accuracy and compliance based on contracts to ensure correct reimbursement.
• Follow up directly with insurance companies regarding payment discrepancies.
• Use aging reports and workflow statuses to address unpaid or open claims over 30, 60, 90, and 120+ days.
• Coordinate benefits (COB) – identify and bill secondary or tertiary insurers.
• Document denials associated with patient responsibility and forward to the collection team.
• Research and appeal denied claims.
• Answer all patient or insurance telephone inquiries pertaining to assigned accounts.
• Report payment discrepancies or denial trends to supervisor as soon as identified.
• Keep supervisor abreast weekly of any concerns or issues associated with accounts.
• Adhere to company standards of compliance with policies and procedures.
• Follow all safety policies and procedures while performing job duties, supporting a culture of high quality and great customer service.
• Perform other duties that may be necessary or in the best interest of the organization.

High School Diploma or GED. CPC, RHIT, CCS, or CMC coding credentials preferred.

3+ years of medical insurance billing. Ophthalmology practice experience 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.
• Positive attitude and flexibility in accepting work assignments and priorities.
• Meets attendance and tardiness expectations.
• Management and organizational skills to support leadership of this function.
• Ability to follow or provide verbal and written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations.
• Interpersonal skills to support customer service, functional, and teammate support needs.
• Ability to communicate effectively in English, both verbally and in writing, and proficiency with Microsoft Excel, Word, PowerPoint, Outlook, practice management software, and clearing house experience.
• Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines.

For on‑site team members, work takes place in a normal office/clinical environment. Travel to other locations may be necessary. Those needing to travel must have dependable transportation and a driving record that meets company liability carrier standards.
Remote work is not available for this position.

Eye Care Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Referred candidates, if any, will also be considered.