[Remote] Revenue Cycle Specialist – Pre-Encounter Financial Clearance

Note: The job is a remote job and is open to candidates in USA. Eye Health America is seeking a Revenue Cycle Specialist – Pre-Encounter Financial Clearance to manage financial clearance activities before patient encounters and scheduled procedures. The role involves verifying insurance eligibility, securing referrals, and preparing Good Faith Estimates while collaborating with internal teams and external partners.

Responsibilities

• Verify patient insurance eligibility and benefits prior to scheduled visits and procedures
• Analyze benefit design, including deductibles, copayments, coinsurance, out-of-pocket maximums, exclusions, and limitations
• Determine whether planned services and procedures align with the patient’s benefit design
• Identify covered and non-covered services and escalate issues as appropriate
• Complete all required financial clearance activities within established timelines
• Identify potential financial risk and communicate findings to appropriate internal teams
• Prepare accurate and compliant Good Faith Estimates (GFEs) for services and supplies in accordance with federal and state regulations
• Obtain referrals and prior authorizations from external physician practices and insurance companies
• Validate authorization details including CPT/HCPCS codes, ICD-10 diagnosis codes, dates of service, number of units, and site of care
• Track authorization status and resolve discrepancies prior to date of service whenever possible
• Apply a working knowledge of CPT, HCPCS, and ICD-10 coding to support benefit determinations and authorization requirements
• Research and interpret payer-specific policies, coverage determinations, and medical necessity guidelines
• Utilize payer portals, policy manuals, and other resources to validate coverage requirements
• Apply insurance regulations and industry rules, including but not limited to: Coordination of Benefits (COB), Medicare Secondary Payer (MSP), Birthday rule for dependent children, Determination of primary vs. secondary insurance coverage
• Maintain awareness of payer and regulatory variations across multiple states
• Work effectively within a team-based environment to support shared goals, coverage needs, and performance expectations
• Collaborate with internal revenue cycle teams, scheduling staff, clinical teams, and ambulatory surgery center leadership
• Partner with Global Partner labor resources to ensure consistent execution of financial clearance workflows
• Provide clear documentation, guidance, and feedback to support quality, accuracy, and process standardization across teams
• Accurately document eligibility, benefit analysis, authorizations, and financial clearance activities in practice management and augmented financial systems
• Adhere to established workflows, quality standards, production expectations and escalation protocols
• Support continuous process improvement initiatives related to pre-encounter financial clearance

Skills

• High School diploma
• 2–4 years of revenue cycle management or medical financial clearance experience
• Working knowledge of CPT, HCPCS, and ICD-10
• Experience with commercial, Medicare, and Medicaid payers and authorization processes
• Demonstrated ability to research and apply payer policies
• Experience supporting physician professional or ambulatory surgical services
• Experience in ophthalmology, eye care or surgical specialties
• Experience with Ambulatory Surgery Centers
• Experience with pharmaceutical benefits and billing
• Experience working within a multistate healthcare organization
• Familiarity with No Surprises Act requirements and GFE workflows
• Experience with practice management systems, EHRs, and payer portals

Company Overview

• EHA is an eye care practice management company. It was founded in 2018, and is headquartered in Alpharetta, Georgia, USA, with a workforce of 1001-5000 employees. Its website is http://www.eyehealthamerica.com/.

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