RCM OPH​/RCM Specialist

Job Description

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, providing services that span the eye care continuum.

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As a member of the Revenue Cycle Management Team, the RCM Specialist is a subject matter expert regarding RCM processes and procedures necessary for Eye Care 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.

• • 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.

High School Diploma or GED

CPC, RHIT, CCS, or CMC Coding Credentials preferred

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…