EyeCare Partners is the nation’s leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visit www.eyecare-partners.com. Job Title: RCM Specialist Must reside in the following states: AL, AZ, FL, GA, IL, IN, KS, KY, MI, MN, MO, NC, NJ, OH, OK, PA, TX, VA Job Summary As a member of the Revenue Cycle Management Team, the RCM Specialist is a subject matter expert regarding RCM processes and procedures necessary for EyeCare Partner Practices. The RCM Specialist may be responsible for multiple elements including, but not limited to: Billing, Coding, Payment Posting, Accounts Receivable (A/R) follow up, insurance claim submission and managing customer services requests from patients Duties and Responsibilities - • Prepare, review, and transmit claims using billing software including electronic, website submission, and paper claim processing - • Post payments both electronically and manually into the practice management system according to set standards and productivity measures. - • Status unpaid claims within standard billing cycle timeframe - • Timely review/handling of insurance claim denials, exceptions, or exclusions - • Forwards requests for medical records to appropriate internal resources - • Addresses/corrects demographic information requested by insurance company - • Ability to read and accurately interpret insurance Explanation of Benefits (EOB’s) - • Verifying insurance payments for accuracy/compliance based on contracts to ensure correct reimbursement is received - • Following up directly with insurance companies regarding payment discrepancies - • Utilizing aging reports and workflow statuses to address any unpaid or open claims over 30, 60, 90, and 120 plus - • Coordination of Benefits (COB) – Ability to Identifying and bill secondary or tertiary - • Documenting denials associated with patient responsibility to forward to the collection team - • Ability to research and appeal denied claims - • Answering all patient or insurance telephone inquiries pertaining to assigned accounts - • Report payment discrepancies or denial trends identified to Supervisor as soon as they are identified for assigned accounts - • Keep supervisor abreast weekly of any concerns or issues associated with accounts - • Adhering to company standards of compliance with policies and procedures - • Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service. - • Performs other duties that may be necessary or in the best interest of the organization. Education, Licensure & Certification Requirements High School Diploma or GED CPC, RHIT, CCS, or CMC Coding Credentials preferred Experience Requirements 3+ years of Medical Insurance Billing. Ophthalmology Practice preferred. Knowledge, Skills and Abilities Requirements - Experience with CPT and ICD-10; Familiarity with medical terminology - Knowledge of billing procedures and collection techniques - Strong written and verbal communication skills - Detail oriented, professional attitude, reliable Consistent production results - Logical, Critical thinking, and research skills - Excellent organization, time management, and prioritization skills - Professional in appearance and actions - Customer-focused with excellent written, listening and verbal communication skills - Enjoys learning new technologies and systems - Exhibits a positive attitude and is flexible in accepting work assignments and priorities - Meets attendance and tardiness expectations - Management and organizational skills to support the leadership of this function - Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations - Interpersonal skills to support customer service, functional, and teammate support need - Able to communicate effectively in English, both verbally and in writing Intermediate computer operation Proficiency with Microsoft Excel, Word, PowerPoint and Outlook Practice management software and clearing houses experience - Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines Location/Work Environment: For on-site team members, work takes place in a normal office/clinical environment. Travel to other locations may be necessary to fulfill the essential duties and responsibilities of the job. Thus, those needing to travel for work must have access to dependable transportation, and their driving record must meet company liability carrier standards. For remote team members, HIPAA compliant home office environment. Ability to work in a remote environment while performing required duties and remaining patient focused. Able to work varying shifts including early mornings/evenings to attend meetings and cross training or support other initiatives. If you need assistance with this application, please contact (636) 227-2600 Please do not contact the office directly – only resumes submitted through this website will be considered EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Please do not contact the office directly – only resumes submitted through this website will be considered NOTE: Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time.

Molina Healthcare is hiring for remote Certified Pharmacy Technicians. These roles will be in our Prior Authorization department. You will review prior auth requests that are submitted. Schedules for these roles will be Mon through Fri 11am-7:30pm MST or 12:30pm-9pm MST. The training schedule will be approximately 7 weeks 9am-5:30pm MST. Qualified candidates must have either PTCB certification or Pharmacy Tech State license. High preference for those who are self-starters and go-getters. Must have above average computer skills along with a high level of communication skills both written and verbal. As a Pharmacy Tech here at Molina, you will provide support for pharmacy technician activities. You will also contribute to overarching pharmacy strategy for optimization of medication related health care outcomes, and quality cost-effective member care. Essential Job Duties - Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved criteria; requests additional information from providers as needed to properly evaluate requests. - Accurately enters approvals or denials of requests. - Facilitates prior authorization requests within established pharmacy policies and procedures. - Participates in the development/administration of pharmacy programs designed to enhance the utilization of targeted drugs and identification of cost-saving pharmacy practices. - Identifies and reports pharmacy departmental operational issues and resource needs to appropriate leadership. - Assists Molina member services, pharmacies, and health plan providers in resolving member prescription claims, prior authorizations, and pharmacy service access issues. - Articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed. Required Qualifications - At least 2 years pharmacy technician experience, or equivalent combination of relevant education and experience. - Certified Pharmacy Technician (CPhT) and/or state pharmacy technician license (state specific if state required). If licensed, license must be active and unrestricted in state of practice. - Ability to abide by Molina policies. - Ability to maintain attendance to support required quality and quantity of work. - Ability to maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA). - Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers. - Excellent verbal and written communication skills. - Microsoft Office suite (including Excel), and applicable software program(s) proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Pharmacy Billing Specialist is responsible for collecting, posting, and managing patient account payments. The position is responsible for submitting patient claims to insurance companies and following up on claims with insurance companies. Supervisory Responsibilities: - This position has no direct supervisory responsibilities. Essential Duties and Responsibilities: - Preparing and submitting clean claims to various insurance companies either electronically or by paper. - Answering questions from patients, clerical staff, and insurance companies. - Identifying and resolving patient billing complaints. - Preparing, reviewing, and sending patient statements. - Evaluating patient’s financial status and establishing budget payment plans; following and reporting the status of delinquent accounts. - Reviewing accounts for possible assignments and making recommendations to the Billing Supervisor. - Preparing information for the collection agency. - Performing various collection actions including contacting patients by phone; correcting and resubmitting claims to third-party payers. - Participating in educational activities and attending monthly staff meetings. - Maintaining the strictest confidentiality; adhering to all HIPAA guidelines and regulations. Qualifications - Detail-oriented and accurate. - Ability to operate a computer, computer software, and basic office equipment. - Ability to operate a multi-line telephone system. - Skilled in answering a telephone in a pleasant and helpful manner. - Ability to read, understand, and follow oral and written instructions. - Ability to establish and maintain effective working relationships with patients, associates, and the public. - Proficiency in reading, writing, and speaking English is required. Requirements - 1 year of medical billing and collections practice experience preferred. - Knowledge of basic medical coding and third-party operating procedures and practices preferred. - Knowledge of business office procedures. Certificates/Licenses/Registration - Pharmacy Technician Certification (PTCB or NHA) required. - Indiana and Pennsylvania State Pharmacy Technician license required. Physical Requirements - Work is performed indoors with potential for exposure to safety and health hazards related to a home office environment. - Could periodically travel to other office and operational sites. - Prolonged periods of sitting at a desk and working on a computer. Benefits - Competitive Medical, Dental, and Vision Insurance. - HSA/FSA. - Voluntary Hospital Indemnity, Critical Illness, Accident Insurance, and Short Term Disability. - Voluntary Life Insurance for Self, Spouse, and Dependent. - Company-paid Basic Life Insurance and Long Term Disability. - Retirement plan and Employer match contribution with Profit Share. - Tuition Reimbursement program. - Company perks and Discount program. - Engaging Wellness and Financial Education Resources. - Employee Assistance Program. - Incentive Plans. Base Hourly Minimum $18.00 Base Hourly Maximum $21.00

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: Claims Review Specialist ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. Summary: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using proprietary software product. Use software to develop standardized reports, meet with clients, respond to coding questions in clear, concise, grammatically correct English, and provide support for other members of the revenue cycle consulting team. Client education, written FAQ answer preparation, and other duties as assigned. ESSENTIAL DUTIES AND RESPONSIBILITIES - Become proficient in the use of the PARA Data Editor, our proprietary software; - Select and review claims for review based on trends/data analysis in the PARA Data Editor; organize information and access to medical documentation. - Audit all aspects of claim including (but not limited to): - Omitted or incorrect charges, - Review OPPS and CAH charges and apply guidelines. - CMS/Payer specific guidelines - Coding accuracy for ICD-10 CM, PCS (if applicable), CPT/HCPCS (including but not limited to 10000-69999, 80000, 90000, J codes, G codes, Q codes, etc) - Departmental review for inaccuracies, omitted data/documentation and charges - NCCI edits, MUE edits, Medi-cal and Medicare guidelines/CMS Manual guidance, - Units of services - E/M Profee/Facility - Documentation improvement. - Assist in preparing written documents for publication under the direction of the Director, HIM, i.e., Q&A entries. - Develop a working understanding of the outpatient hospital reimbursement process, including documentation, coding, and billing. - Participate in presentations to clients and prospective clients, typically over web meetings. - Develop and maintain the skills and knowledge necessary related to the assigned specialty areas and the related services. Keep current on all related information from journals and bulletins. Distribute and pass on all necessary materials, including copying for reference files when relevant. QUALIFICATIONS - 5+ years of directly related experience - Expert knowledge in revenue cycle and Outpatient coding (ER, SDS, OBS, ancillary, IR, Profee, E/M facility, I&I) - CCS, COC or CPC certification required - Medical Terminology and anatomy knowledge is required - Clinical Documentation and Inpatient coding experience is preferred. New hires will be expected to learn IP during employment. - Must have strong understanding of revenue cycle, CMS Manual/guidelines, Medicaid guidelines. - Strong Microsoft Excel, PowerPoint, Word and OneNote skills - Must have strong understanding of the Official Coding Guidelines, OP coding and billing (i.e. including but not limited to knowledge of rev codes, HCPCS, MUE and CCI edits, UoS) - Strong analytical capability, independent thinker and good decision-making skills - Excellent written and verbal communication and presentation skills - Strong computer and technology knowledge and skills - Highly professional demeanor, great client satisfaction skills - Maintain current certifications and accreditations (as applicable). - Research new guidelines, data elements, payer specifications, etc - Other duties may be assigned as necessary. PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.