RCM - Claims Specialist Billing

Keplr Vision in Bloomington, IL  

*US Based only

Position Title: RCM Claims Vision Specialist
Department: Revenue Cycle Management
Reports To: Team Lead or Manager, Revenue Cycle Management

Job Description:

 The Accounts Receivable (AR) Aging Specialist is responsible for managing and resolving outstanding insurance and patient accounts to ensure timely reimbursement and reduce aging accounts receivable. This role works directly with payers, practices, and internal teams to investigate claim issues, resolve denials, identify underpayments, and drive account resolution while maintaining productivity and quality standards.

Primary Responsibilities:
AR Management

• Review and work assigned AR inventory daily.
  
• Analyze unpaid, underpaid, and denied claims.
  
• Identify root causes of outstanding balances and take appropriate action.
  
• Submit corrected claims, appeals, reconsiderations, and supporting documentation as needed.
  
• Follow up with insurance carriers regarding claim status and payment delays.
  
• Resolve patient and insurance balances within established aging guidelines.
  
• Document all account activity accurately and thoroughly.

Denial Management

• Investigate denial trends and identify opportunities for process improvement.
• Research payer policies and billing guidelines.
• Prepare and submit appeals within payer filing deadlines.
• Escalate recurring denial issues to leadership when appropriate.

Payment Variance Resolution

• Research underpayments and contractual discrepancies.
  
• Identify payer reimbursement issues and coordinate resolution.
  
• Monitor outstanding recoupments and refund requests.

Collaboration

• Partner with Billing, Cash Posting, Patient Collections, Credentialing, and Practice Operations teams.
  
• Participate in practice meetings and account reviews as assigned.
  
• Communicate account issues and trends to leadership.

Quality & Compliance

• Maintain compliance with payer regulations, HIPAA requirements, and company policies.
  
• Ensure all account activity is documented accurately.
• Participate in quality assurance reviews and coaching sessions.
  

Required Qualifications

• High School Diploma or GED required
  
• 3-5 years of Vision medical billing, AR, collections, or denial management experience
  
• Experience working with commercial, Medicare, Medicaid, and vision insurance preferred
  
• Knowledge of EOBs, ERA remittances, claim appeals, and payer follow-up processes
  
• Strong analytical and problem-solving skills
  
• Proficient in Microsoft Office, including Excel
  
• Excellent written and verbal communication skills

 Qualifications

• Ophthalmology or Optometry revenue cycle experience only 
  
• Multi-location healthcare experience
  
• Experience with OfficeMate, RevolutionEHR, Eyefinity, Compulink, AcuityLogic, or similar practice management systems