The RCM Billing Associate is responsible for performing daily billing functions as assigned, executing all aspects of RCM workflows to ensure optimal revenue collections while delivering superior patient assistance. In addition, the RCM Billing Associate strives to meet or exceed the daily, weekly and monthly goals and objectives while also collaborating with other team members and Departments to meet the needs of NEC and the patients. as described in the Organization’s mission statement. The RCM Billing Associate makes sure each patient has an exceptional experience and promotes an environment where every patient will truly “See the Difference Caring Makes.”

Job Responsibilities

DUTIES AND RESPONSIBILITIES:

• Independently run daily reports for task assignments
• Responsible for analyzing and interpreting both vision and medical insurance plan benefits and distinguishing the order of claim submission
• Responsible for submitting vision claims either electronically or via paper with knowledge of the requirements as defined by the payers of a “clean claim”
• Validation of complete and accurate patient’s orders
• Possess the knowledge and familiarity of CPT and ICD-10 codes for Vision versus Medical

Insurance benefit coverage

• Routinely assess and qualify a medical versus vision service and direct claim/order submission accordingly
• Communicate effectively with the Front Desk staff, Opticians, Technicians and Doctors to resolve errors or missing information on Superbills/patient orders
• Accurately file/submit vision claims on a daily basis and in a timely manner (EyeMed, VSP, Spectara, etc.)
• Effectively and efficiently incorporate the daily use of payer portals to submit claims/orders with research and follow-up of unpaid claims as assigned.
• Responsible for filing secondary/tertiary/COB claims as assigned with accuracy and timeliness
• As assigned, post patient payments (cash, checks, credit cards) and insurance payments including appropriate and accurate contractual adjustments
• As assigned, post insurance EFT payments accurately and timely
• Assist with assessment and generating patient statements and processing the same for mailing
• Assist with researching and responding to patient inquiries regarding their account balances. Identify and resolve all patient billing complaints in a professional and timely manner.
• Routinely assess the workflow of RCM with a focus on establishing and maintaining best practices
• Keep up to date with federal, state and local billing regulations along with the policies and procedures of private insurers
• Work independently in an efficient and effective manner on all assigned tasks
• Routinely communicate with the RCM Billing Coordinator regarding the status of tasks, filing issues training needs, etc.
• Prepare Recall Postcard as assigned
• Abide by HIPAA privacy standards

Required Skills and Qualifications

Special knowledge or skills:

• Strong written and oral communication skills
• Knowledge of medical billing and coding processes and rules
• Knowledge of and ability to utilize healthcare computer and EMR software
• Knowledge of HIIPA guidelines
• Knowledge of Federal, state, and local billing regulations
• Knowledge of medical versus vision plan billing
• Ability to work independently/self-starter
• Ability to sit for extended periods