Revenue Cycle Management Specialist

EyeCare 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. For more information, visit www.eyecare-partners.com.

SECTION 1: Job Summary (Summary of the basic functions of 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.

SECTION 2: Duties and Responsibilities (Responsibilities necessary to accomplish job functions)

• 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.

SECTION 3: Patient Population Served (For nursing / patient care positions)

• This position does not serve the patient population

SECTION 4: Education, Licensure & Certification Requirements

SECTION 5: Experience Requirements

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

SECTION 6: 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

SECTION 7: Supervisory Responsibilities:

• This role does not have any supervisory responsibilities

SECTION 8: PHYSICAL DEMANDS:

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 essential duties and responsibilities of the job. Thus, those needing to travel for work must have access to dependable transportation, and driving record must meet company liability carrier standards.

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.

Exposure: Works in normal office environment during normal business hours. May be exposed to blood or bodily fluids. May also be exposed to various cleaning supplies.

Equipment: The equipment typically used in this position is a computer, fax, copier, printer, scanner and telephone. Must have good working knowledge of Microsoft applications. Other equipment may be used as needed. Personal Protective Equipment (PPE) follows standard precautions using personal protective equipment.