Introduction

Retina Consultants of America is identifying and evaluating candidates for the position of Revenue Cycle Billing Specialist. This position will report to the manager of RCM Supervisor. The revenue cycle AR specialist role is a highly visible and challenging role that will help execute the vision of the company’s long-term and short-term strategy and become an integral member of a dynamic and experienced operational team.

Our Company

Retina Consultants of America (RCA) is bringing together national leaders in surgical and clinical retina care. This network comprises preeminent retina research specialists with the common goal of eradicating blindness caused by macular degeneration, diabetic retinopathy, and other retina diseases.

With over 2.3M annual patient visits, more than 315 physicians, and more than 290 locations, Retina Consultants of America (RCA) is the largest retina care provider in the nation.

Our Mission

Through RCA’s physician-centered practice management model, physicians continue to drive clinical care and practice culture, while benefiting from the business expertise, resources and share best practices.

RCA seeks to expand our mission by partnering with leading retina specialists who are passionate about delivering excellent patient care and participating in innovative research.

RCA has created a business model that enables retina specialists to retain autonomy and ownership, augmented by sharing best practices facilitated through the Medical Leadership Board and executive management support. Practices within the network will continue to drive all clinical decisions and remain highly involved in strategic operations.

Our Core Values

· Relentlessly Commit to our Patients, to the Practices We Serve and to Our Mission

· Embrace the Legacies of Our Partner Practices

· Strive for Continuous Improvement Through Education and Research

· Exude Compassion in All We Do

Position Overview

The Revenue Cycle Billing Specialist is responsible for resolution of outstanding A/R including correcting billing errors, refiling claims, appealing denials, and payment posting for RCA Partner Practices. They will collaborate with key stakeholders, practice RCM leaders, and other departments within the company to ensure that all key project milestones and timelines are achieved. The Revenue Cycle Billing Specialist role requires strong expertise in insurance procedure for referrals, authorizations, copays, and deductibles. A successful AR Specialist should be detail-oriented, accurate, accountable, balanced, with sound business judgment, and aligned with company objectives.

Essential Duties and Responsibilities

• Ensure accurate submission of insurance claims and verify patient information.
• Follow up on unpaid claims, resolve discrepancies with insurance companies, and ensure timely reimbursement.
• Post payments from insurance companies and reconcile accounts to accurately reflect all payments.
• Communicate with patients about outstanding balances, set up payment plans, and process patient payments.
• Compile, analyze, and report data regarding performance and trends.
• Identify and resolve any claim denials by collaborating with insurance companies and resubmitting claims as necessary.
• Implement continuous improvements for policies, procedures, and processes to align with RCA “best practices”
• Maintain relationships with vendors and insurance provider representatives
• Maintain expertise in retina-specific coding and billing
• Maintain knowledge of and comply with established policies and procedures including government, insurance, and third-party payer regulations
• Work collaboratively with practice staff and physicians
• Any other project as determined by the Director of RCM Operations

Knowledge, Skills, Abilities

• Strong physician billing experience in ophthalmology/retina
• Strong understanding of commercial health insurance, and federal and state coverage
• Strong organizational, customer service, interpersonal, facilitation, communication, and time management skills
• Outstanding poise in a fast-paced business environment
• Ability to work both independently and in a team setting
• Flexibility to travel as needed

Education and Experience

• Minimum of 3 years’ experience in medical A/R follow up
• Billing/coding certification preferred, but not required
• Proficient in Microsoft Office (Excel, Word, PowerPoint)
• Proficient in Microsoft Outlook
• Experience and ability to navigate practice EHR PM systems and RCM/data reporting tools (NextGen, Nextech, Tableau, Viewgol experience, a plus)

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person