RCM Specialist-Routine Vision

Role And Responsibilities

• Respond to inquiries from insurance carriers, via telephone, email or fax and demonstrate a high level of customer service.
• Pursue reimbursement from carriers by placing phone calls and documenting all communication in Athenahealth to ensure progress is made on outstanding accounts.
• Identify and respond to patterns of denials or trends and perform complex account investigation as needed to achieve resolution.
• Review and resolve uncollected accounts and prepare charge corrections.
• Appeal carrier denials through review of coding, contracts, and medical records.
• Call insurance companies regarding any discrepancy in payments if necessary.
• Identify and bill secondary or tertiary insurances.
• Research and appeal denied claims.
• Set up patient payment plans.
• Verify patient benefit eligibility/coverage and research ICD-10 diagnosis and CPT treatment codes as needed.
• Advise management of any trends regarding insurance denials to identify problems with payers.
• Complete required reports and assist with special projects as assigned.

Essential Qualifications

• Education/experience: High School Diploma or General Education Degree (GED) with 3 years prior hands-on experience in a fast-paced medical billing environment. Must have previous experience in a healthcare setting.
• Familiarity with CPT and ICD-10 is also required; CPC certification is a plus.
• Strong communication, including writing, speaking and active listening
• Great customer service skills, including interpersonal conversation
• Good problem-solving and critical thinking skills
• Organization, time management and prioritization abilities
• Ability to be discreet and maintain the security of patient or customer information
• Effective computer skills with practice management software
• Understanding of industry-specific policies, such as HIPAA regulations for health care
• Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid
• Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems
• Effective communication abilities for phone contacts with insurance payers to resolve issues
• Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members
• Able to work in a team environment
• Problem-solving skills to research and resolve discrepancies, denials, appeals
• Knowledge of medical terminology
• Knowledge of CPT/ICD-10 and modifier coding.