JOB SUMMARY:

The Revenue Cycle Management (RCM) Coordinator is responsible for filing insurance claims, managing patient accounts, and answering inquires on account status and charges from optometry and ophthalmology patients.  They collect and enter claim information, post insurance and patient payments and follow up on unpaid and rejected claims in a timely fashion. Also held accountable for documenting all customer interactions in the appropriate computer system. Representative reports directly to the Revenue Cycle Manager.

ESSENTIAL FUNCTIONS:

• Enters information necessary for insurance claims such as patient insurance ID, diagnosis and treatment codes and modifiers and provider information. Insures that claim information is concise, complete, and accurate.
• Submits insurance claims to clearinghouses or individual insurance companies electronically or via paper CMS-1500 form.
• Answers patient questions on patient responsible portions, copays, deductibles, write-offs, etc. Resolves patient complaints or explains why certain services are not covered while demonstrating positive customer relationship skills with all telephone encounters.
• Follows up with insurance companies on unpaid or rejected claims. Resolves issues and re-submits claims.
• Prepares appeal letters to insurance carriers when not in agreement with claim denial. Collects necessary information to accompany appeal.
• Prepares patient statements for charges not covered by insurance. Ensures that statements are mailed on a regular basis.
• Follows up on past due patient balances and provides necessary information to collection agencies for delinquent accounts.
• May perform “soft” collections for patient past due accounts. This may include contacting and notifying patients via phone or mail.
• Posts insurance and patient payments using medical claim billing software, and prepares and submits secondary claims upon processing by primary insurer.
• Understands managed care authorizations and limits to coverage such as number of visits.
• Verifies patient benefits eligibility and coverage.
• Meets outlined AVP benchmarks and/or quality indicators as monitored through audits or recordings. 
• Meets the expectations of our internal and external customers in providing excellent service.
• Supports organizational changes. Demonstrates flexibility in providing coverage and/or availability for the insurance department via scheduling adjustments for unexpected absences, events, or work volume variances.
• Processes Patient and Insurance Carrier refunds.
• Other duties and special projects that are assigned by management.
• Follows HIPAA guidelines in handling patient information.

Essential Skills and Abilities:

• Patient centered care focused, and a team player.
• Handles multiple tasks effectively and efficiently, and exhibits commitment to effective problem-solving techniques when issues arise.
• Continuously acts to maintain a safe, clean, healthy, and fun work environment consistent with AVP’s Mission and Vison.
• Arrives on time, ready to work, and demonstrates minimal absenteeism.
• Demonstrates effective problem-solving skills
• Knowledgeable of Medicare and Medicaid billing and reimbursement concepts and principles.

REQUIRED COMPETENCIES:

• Excellent judgment, dependability, and conscientiousness.
• Demonstrated high ethical standards and integrity.
• Demonstrated attention to detail.
• Demonstrated accuracy and thoroughness; monitors own work to ensure quality.
• Customer and patient service orientation: prompt response to patient needs and ability to manage difficult or emotional customer situations with tact, empathy and diplomacy.
• Ability to work cooperatively in group situations; offers assistance and support to coworkers, actively resolves conflicts, inspires trust of others, and treats patients and coworkers with respect.

EDUCATION AND EXPERIENCE:

• High School Diploma or equivalent required.
• Computer skills that include a combination of experience in a Windows Operating System, e-mail, and data entry experience.
• Prior experience with Medical billing software is preferred but not required.
• Three to five years in insurance billing required.

PHYSICAL DEMANDS

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical demands: While performing the duties of this job, employee is required to walk frequently; sit frequently; use hands to handle, or feel objects, tools, or controls frequently; reach with hands and arms; talk and hear and communicate with speech clarity continually; climb, balance, and stoop, kneel, and bend occasionally. Employee must lift and/or move 30 pounds occasionally.

Work environment: Setting typical of a call center environment and business office. Occasional travel to ophthalmology medical practices with office type features.  Travel is roughly 10%.