This on-site role at Prism Vision Group involves handling billing and collections for assigned payors, ensuring accounts are billed properly and comply with regulatory requirements.

Responsibilities include responding to insurance carrier inquiries via phone, email, and fax; pursuing reimbursements and documenting communications in Athenahealth; investigating denials and resolving uncollected accounts; appealing carrier denials through review of coding, contracts, and medical records; verifying patient eligibility and researching ICD-10 and CPT codes; advising management of insurance denial trends; and supporting management with reports and special projects.

Qualifications require a High School Diploma or GED with 3 years of hands-on experience in a fast-paced medical billing environment within healthcare. Familiarity with CPT and ICD-10 coding is required; CPC certification is a plus. Strong communication, customer service, problem-solving skills, HIPAA understanding, knowledge of insurance guidelines (HMO/PPO, Medicare, Medicaid), and medical terminology knowledge are essential. Candidates must work well in a team, maintain patient information confidentiality, and be proficient with practice management software.

High School Diploma or GED
Minimum 3 years medical billing experience in healthcare setting
Familiarity with CPT and ICD-10 codes; CPC certification preferred
Strong verbal and written communication skills
Excellent customer service abilities
Problem-solving and critical thinking skills
Organization and time management
Ability to maintain confidentiality of patient information
Proficient with practice management software
Understanding of HIPAA regulations
Knowledge of insurance payor requirements and systems, including HMO/PPO, Medicare, Medicaid
Effective communication skills for interaction with insurance payers and patients
Ability to work in a team environment
Knowledge of medical terminology

Revenue Cycle Management Specialist - Routine Vision