Revenue Cycle Billing Specialist - Ophthalmology

Position Summary:

The Revenue Cycle Billing Specialist is responsible for managing the end-to-end billing and collections process to ensure accurate and timely submission of claims, payment posting, and resolution of outstanding accounts. This role requires experience with EMR software (ideally Modernizing Medicine (ModMed)) and a strong understanding of ophthalmology/medical billing workflows.

Key Responsibilities:

• Review clinical documentation to ensure accuracy with CPT, HCPCS, and ICD-10 codes for office visits, diagnostic testing, imaging (e.g., OCT, FA), and surgical procedures
• Prepare, review, and submit electronic and paper claims to insurance companies using ModMed EHR and billing modules.
• Create, test, and maintain claim scrub rules in ModMed to ensure accurate coding and reduce claim denials.
• Verify insurance coverage and eligibility for patients as needed.
• Post insurance and patient payments accurately, including adjustments and denials.
• Research and resolve claim denials, rejections, and underpayments to ensure maximum reimbursement in conjunction with our remote A/R billing team.
• Monitor payment collections and investigate discrepancies or underpayments.
• Perform patient account follow-ups, including collection calls and statements.
• Process copay assistance claims and ensure all required documentation is complete and accurate.
• Generate and analyze billing, variance, and A/R reports to identify trends and areas of improvement.
• Assist with inventory tracking and reconciliation of billable medications and medical supplies.
• Audit provider documentation for accuracy and completeness; provide feedback and training as needed.
• Assist with month-end reconciliation and reporting as needed.
• Provide timely and professional responses to patient inquiries regarding billing, insurance coverage, and payment options via phone, email, and Klara/patient portal.
• Contact patients to discuss outstanding balances and assist in setting up or managing payment plans in accordance with practice guidelines.

Revenue Integrity:

• Monitor coding patterns to ensure compliance with federal and commercial payer regulations.
• Identify and correct coding and billing discrepancies, working proactively to reduce denials and rejections.
• Collaborate with billing and clinical teams to resolve coding-related claim issues promptly.

Compliance & Education:

• Stay up to date on coding changes, CMS regulations, and payer policies relevant to ophthalmology and retina care.
• Educate physicians, scribes, and technicians on proper documentation and coding protocols.
• Participate in internal audits and external reviews, preparing documentation and follow-ups as required.
• Maintain compliance with HIPAA and federal/state billing regulations.

Reporting & Analysis:

• Track denial trends and underpayments related to coding; propose process improvements.
• Assist with revenue cycle metrics, coding accuracy KPIs, and compliance dashboards.

Qualifications:

• Experience: Certified Professional Coder (CPC), Certified Ophthalmology Coder (COC), or equivalent certification required.
• Years of Experience Required: Minimum 3 years of medical billing experience; ophthalmology experience preferred.
• Software: Proficiency in Modernizing Medicine (ModMed) EMA required or similar ophthalmology-focused platforms a plus.
• Knowledge: Strong understanding of CPT, ICD-10 coding, insurance claims, and payment posting. Deep knowledge of Medicare and commercial payer rules, with special emphasis on retina-specific billing (e.g. retina injections, imaging bundling rules). Strong understanding of medical necessity documentation.
• Skills: Excellent attention to detail, problem-solving, and communication skills.
• Other: Ability to manage multiple tasks, meet deadlines, and work independently or as part of a team.

Preferred Skills:

• Familiarity with ophthalmology or optometry billing, including procedures, diagnostic codes, and insurance requirements.
• Experience with revenue cycle analytics and reporting.
• Knowledge of prior authorization workflows and claim appeal processes.

Disclaimer:

This job description is intended to describe the general nature and level of work being performed by individuals assigned to this position. It is not an exhaustive list of all duties, responsibilities, or qualifications associated with the job. The Practice reserves the right to modify, add, or remove duties and to amend this job description at any time, with or without notice, in accordance with applicable federal and New York State laws.

Job Type: Full-time

Pay: $25.00 - $28.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Vision insurance

Application Question(s):

• Do you have experience with EMR softwares?
• Do you have experience in ophthalmology?
• Is there anything else you'd like us to know about you?

Education:

• High school or equivalent (Required)

Experience:

• Medical Billing Experience - Ophthalmology: 3 years (Required)

Ability to Commute:

• Halfmoon, NY 12065 (Required)

Work Location: In person

Salary : $25 - $28