RCM Claims Vision Specialist

Primary Responsibilities

• Review and work assigned AR inventory daily.
• Analyze unpaid, underpaid, and denied claims.
• Identify root causes of outstanding balances and take appropriate action.
• Submit corrected claims, appeals, reconsiderations, and supporting documentation as needed.
• Follow up with insurance carriers regarding claim status and payment delays.
• Resolve patient and insurance balances within established aging guidelines.
• Document all account activity accurately and thoroughly.

Denial Management

• Investigate denial trends and identify opportunities for process improvement.
• Research payer policies and billing guidelines.
• Prepare and submit appeals within payer filing deadlines.
• Escalate recurring denial issues to leadership when appropriate.

Payment Variance Resolution

• Research underpayments and contractual discrepancies.
• Identify payer reimbursement issues and coordinate resolution.
• Monitor outstanding recoupments and refund requests.

Collaboration

• Partner with Billing, Cash Posting, Patient Collections, Credentialing, and Practice Operations teams.
• Participate in practice meetings and account reviews as assigned.
• Communicate account issues and trends to leadership.

Qualifications

• High School Diploma or GED required.
• 1-2 years of Vision medical billing, AR, collections, or denial management experience.
• Experience working with commercial, Medicare, Medicaid, and vision insurance preferred.
• Knowledge of EOBs, ERA remittances, claim appeals, and payer follow-up processes.
• Strong analytical and problem-solving skills.
• Proficient in Microsoft Office, including Excel.
• Excellent written and verbal communication skills.