Retina Billing Specialist

Role: Billing Specialist - Retina

Location: Fully Remote

Pay Range: $24 – $30 / hour

Schedule: Monday–Friday, 8:00 AM–5:00 PM in the assigned practice's time zone

Employment Type: Direct Hire

Benefits: This role is eligible for medical, dental, vision and 401k.

About Our Client

Addison Group is hiring for our client, a rapidly growing specialty healthcare organization, seeking experienced Billing Specialists to support its expanding revenue cycle operations. Due to continued growth and new practice acquisitions, the organization is adding multiple professionals with a strong background in retina and ophthalmology billing.

Although titled Billing Specialist, this position is heavily focused on insurance AR follow-up, denial resolution, and professional claims. Candidates must have hands-on retina billing experience and a solid understanding of injectable drug billing.

Job Description

The Billing Specialist will manage physician insurance claims throughout the revenue cycle, with a primary focus on resolving unpaid and denied accounts. This position requires specialized knowledge of retina billing, J-codes, drug units, modifiers, and reimbursement.

The role is entirely insurance-focused and does not involve patient collections or discussions regarding patient payment plans.

Key Responsibilities

• Perform insurance AR follow-up on outstanding and denied physician claims
• Research claim denials and determine the appropriate steps for resolution
• Prepare and submit corrected claims, reconsiderations, and formal appeals
• Review professional claims for accuracy and completeness before submission
• Work with retina-specific J-codes, injectable medications, drug units, and modifiers
• Research reimbursement issues involving both commercial and government payers
• Manage a significant volume of Medicare and Medicare-related claims
• Assist with payment posting and charge entry when needed
• Partner with billing team members to identify claim errors and prevent recurring issues
• Utilize payer portals and billing systems to research claim status and reimbursement
• Maintain detailed documentation of account activity and follow-up efforts
• Support assigned specialty practices located throughout the country
  
  

Qualifications

• 1 year of recent retina billing experience required
• Hands-on experience with physician/professional fee billing
• Strong working knowledge of J-codes and injectable drug billing
• Experience applying and researching appropriate billing modifiers
• Knowledge of insurance AR follow-up and denial management
• Experience working with commercial and government insurance plans
• Ability to read and interpret EOBs and payer responses
• Strong analytical and problem-solving skills
• Comfortable managing a high-volume workload in a remote environment
  
  

Specialized Retina Experience

Qualified candidates should have familiarity with several of the following:

• Billing for intravitreal injections and specialty ophthalmic medications
• Retina-specific J-codes and appropriate drug units
• Drug reimbursement and buy-and-bill processes
• Benefits verification for injectable medications
• Prior authorization requirements for retina treatments
• Common ophthalmology modifiers, including laterality and procedure-related modifiers
• Resolving denials involving injectable medications and physician services
  
  

Work Environment

• 100% remote position
• Full-time Monday–Friday schedule
• Candidates may support a practice operating in a different time zone and should be comfortable working the assigned practice's business hours
• Collaborative and expanding Revenue Cycle team
• Structured onboarding and systems training provided
  
  

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.

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