RCM Support Services Specialist

RCM Support Services Specialist

US Eye is a physician-led, patient-centric network of eye care practices committed to providing exceptional patient service through premium technology and unrivaled provider expertise. We deliver world-class care to patients throughout Florida, the Carolinas, and Virginia.

JOB SUMMARY: The RCM Support Services Specialist is responsible for ensuring a seamless and transparent financial experience for patients while maintaining accuracy throughout the revenue cycle. This role supports the billing and clinical teams by addressing patient billing inquiries, reviewing and updating claims, identifying charge posting or payment errors, reviewing authorizations, and performing financial clearance for upcoming procedures. The specialist also provides real-time cost estimates for office visits, diagnostic testing, and surgeries. The ideal candidate will have a strong understanding of ophthalmology and retina billing, payer authorization requirements, and a dedication to patient-centered financial communication.

Essential Job Functions:

• Patient Financial Support
• Respond promptly and professionally to patient billing and statement inquiries while on-site or by phone.
• Clearly explain insurance benefits, copayments, deductibles, and out-of-pocket costs related to ophthalmology and retina services (e.g., OCT, fluorescein angiography, intravitreal injections, cataract or retina surgeries).
• Patient education regarding billing/statement questions
• Assist patients with payment options, including financial assistance options, and understand their financial responsibilities.
• Escalate/triage to Financial Clearance Teams when applicable.
• Coordinate with the appropriate RCM Support teams for resolution of any billing issues & monitor the timely completion of those requests.

• Claims and Payment Management
• Research, update, and correct claim data to ensure timely and accurate submission.
• Identify and resolve charge posting or payment errors, including misapplied payments, incorrect adjustments, and missing transactions.
• Collaborate with billing and coding teams to correct denials or rejections and prevent recurrence.
• Escalate/triage to Accounts Receivables (A/R), Charge Posting, and Payment Posting Teams when applicable.

• Authorizations & Financial Clearance
• Review patient accounts prior to visits, procedures, or surgeries to confirm all authorizations and referrals are valid and current.
• Verify insurance eligibility and benefits for current appointments and provide patients with detailed information pertaining to their health plan design.
• Coordinate with clinical and scheduling teams to ensure all services are authorized and financially cleared before the date of service.
• Escalate missing or delayed authorizations promptly to minimize denials and scheduling disruptions.

• Estimates and Cost Transparency
• Generate accurate, real-time ("on-the-fly") cost estimates for office visits, diagnostics, injections, and surgeries using payer information and practice fee schedules.
• Triage complex or multi-procedure estimate requests for financial counseling review and patient communication.

• Workflow Efficiencies & Implementation of Enhanced Technology
• Participation in a working session with other RCM team members to discuss opportunities for improvement.
• Work closely with RCM senior leadership on addressing issues and implementing agreed-upon solutions in a timely manner.

• Administrative and Operational Support
• Document all patient and payer communications accurately in the EHR/billing system. Collaborate across teamsscheduling, authorizations, billing, and clinicalto ensure accurate financial data and a smooth patient experience.
• Escalate complex financial or insurance issues to RCM leadership for resolution.

Other Duties and Responsibilities:

• During non-peak times, providing additional RCM Support within other departments (i.e., patient assistance enrollments, shipments, and replacement drugs), A/R Support (Claim status for unresponded to claims, review and outreach to patients with large outstanding balances and accounts in pre-list status, targeted denial management).

Competencies:

• Expertise in insurance verification, authorization management, financial clearance and AR billing functions. Strong analytical skills for identifying and resolving charge posting, payment errors and payer denials.
• Excellent written and verbal communication with a compassionate, patient-centered approach.
• Proficiency with EHR and billing platforms (e.g., NextGen and Intellichart Pro, etc). Exceptional attention to detail, organization, and multitasking ability in a fast-paced environment.

Education and Experience:

• High school diploma or GED required; associate degree or certification in medical billing preferred.
• Minimum 23 years of experience in ophthalmology or retina billing, authorizations, or RCM support.
• Strong understanding of CPT/ICD-10 coding, payer policies, and modifier use specific to ophthalmology and retina services (e.g., injections, bilateral procedures, global periods).

Position Type and Expected Hours of Work:

• This is a full-time position located near Elizabeth City, NC
• Standard business hours with occasional flexibility for pre-surgical or month-end workload.
• Travel to other locations as necessary
• In-office with a possible hybrid work environment during less peak times.

Physical Demands:

• Prolonged periods of sitting at a desk and working on a computer.
• The noise level in the work environment is usually moderate.
• Moderate lifting 10-50lbs
• Hybrid role
• Ability to travel between locations as necessary

Benefits:

• 401(K) Company Match
• Medical and Dental Insurance
• Flexible Spending Accounts
• Pet Insurance
• Disability Insurance Life Insurance
• Continuing Education
• Paid Time Off

US Eye provides equal employment opportunities to all employees and applicants for employment. It prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.