Revenue Cycle Specialist

Position Summary

The Revenue Cycle Specialist is responsible for optimizing revenue and ensuring the accuracy and compliance of all billing and coding practices within a healthcare organization. This role involves analyzing and auditing claims, providing education and training to staff, and implementing processes to enhance revenue integrity.

Essential Functions and Responsibilities

• Review and audit claims, medical records, and documentation to identify errors, discrepancies, or compliance issues.
• Verify that services provided are correctly documented, coded, and billed according to payer and regulatory requirements.
• Work to maximize revenue by identifying opportunities for additional billable services, coding accuracy, and reducing claim denials.
• Analyze reimbursement rates and fee schedules to ensure the organization is being reimbursed appropriately.
• Provide training and education to clinical and administrative staff on coding and documentation best practices.
• Stay updated on changes in coding and billing guidelines and share this information with relevant staff.
• Monitor compliance with healthcare regulations, including CMS (Centers for Medicare & Medicaid Services) and third-party payer requirements.
• Ensure that all billing and coding practices align with regulatory standards.
• Analyze data and prepare reports on key performance indicators related to revenue integrity, such as coding accuracy, claim denial rates, and reimbursement trends.
• Identify and implement process improvements to enhance revenue integrity, streamline workflows, and reduce errors.
• Collaborate with relevant departments to resolve issues and enhance revenue cycle processes.
• Assist coders and clinical staff with complex coding scenarios and documentation requirements.
• Conduct regular chart reviews and provide feedback to improve documentation quality.

Benefits

As a team member at Eye Health America, you'll enjoy:

• Medical, Dental, Vision, Short-term Disability, Long-term Disability, Life Insurance, etc.
• Matching 401(k)
• Employee Discount
• Wellness Program
• Paid Vacation & Holidays
• Uniform Allowance
• Training/Advancement opportunities

About Us

At Eye Health America, we support the expansion of leading eye care practices across the Southeastern United States through both organic growth and strategic partnerships. Led by an experienced team of eye care industry leaders with more than 100 years of combined practice management experience, we partner with best-in-class practices and ambulatory surgery centers to deliver full-service, integrated eye care. Our focus is to provide the operational, strategic, and administrative support that allows our providers and teams to stay focused on what matters most—delivering exceptional clinical care and an outstanding patient experience. Together, we are building a network of trusted practices dedicated to meeting the growing demand for high-quality eye care while making a meaningful impact in the communities we serve.

Our Purpose

Making lives better with personalized eyecare.

Our Values

People-Focused - Our people are the secret to our success. We are defined by our shared values and demonstrate them in every interaction. They guide us and ensure we are in an inclusive place where our teammates love to work, and our patients are delighted to visit.

Heartfelt Service - With helpful hands and open minds and hearts, we actively engage with our individual locations, celebrating their unique local style, while identifying solutions to support improved service.

Mutual Respect - We share ideas, collaborate, and troubleshoot as a team, seeking alignment in decision-making. By supporting and equitably empowering one another, we discover new ways to create value.

Honesty & Transparency - We act with integrity and transparency without fear of speaking up or disrupting the status quo. We communicate clearly and respectfully with everyone.

Result-Oriented - Analysis improves our decision-making. We strive to track all facets of our business to develop insights for improved care. Best performance is derived from strong leadership, setting goals, executing plans, monitoring results, and reinforcing successful approaches.

Growth Mindset - We seek to grow our people, services, markets, and overall company to create value. Always looking forward, we explore new technologies, treatments, systems, and processes for improvement.

• Bachelor's degree in a related field, such as healthcare administration, health information management, or nursing. Relevant certifications (e.g., Certified Professional Coder - CPC) may be preferred.
• Several years of experience in healthcare billing, coding, or revenue cycle management, with a focus on revenue integrity.
• Eyecare experience preferred.