The Ophthalmic Billing Specialist is responsible for managing the medical billing process for an eye care practice, including ophthalmology and optometry services. This position ensures accurate claim submission, payment posting, insurance follow-up, denial management, and patient account resolution while maintaining compliance with all insurance and HIPAA regulations.

The ideal candidate is detail-oriented, organized, knowledgeable in medical insurance, and able to work efficiently in a fast-paced clinical environment.

Essential Duties & Responsibilities

Insurance & Claims Processing

• Submit electronic and paper claims accurately and timely
• Review claims for coding accuracy and completeness prior to submission
• Correct and resubmit denied or rejected claims
• Monitor claim status and follow up with insurance carriers
• Verify payer requirements and filing deadlines

Payment Posting & Reconciliation

• Post insurance and patient payments accurately
• Reconcile daily deposits and payment batches
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs)
• Identify and resolve payment discrepancies

Denial & Accounts Receivable Management

• Investigate denied, underpaid, or unpaid claims
• Appeal denied claims when appropriate
• Work aging accounts receivable reports
• Maintain acceptable A/R benchmarks and reduce outstanding balances

Ophthalmology & Optometry Billing

• Bill routine vision and medical eye care services
• Understand modifiers, diagnosis coding, and ophthalmic procedures
• Process claims for:
  • Cataract surgery
  • Premium lenses
  • Injections
  • Diagnostic testing
  • Office visits
  • Refractions
  • Optical-related charges as applicable

Patient Financial Services

• Answer patient billing questions professionally
• Review patient balances and payment arrangements
• Assist with estimates and insurance benefit explanations
• Maintain confidentiality regarding all patient financial information

Compliance & Documentation

• Maintain HIPAA compliance at all times
• Stay current on insurance regulations and billing updates
• Document account activity thoroughly and accurately
• Follow practice policies and procedures

Qualifications

Required

• High school diploma or equivalent
• Minimum 1–2 years of medical billing experience
• Knowledge of CPT, ICD-10, and insurance claim processing
• Experience with commercial insurance, Medicare, and Medicaid
• Strong computer and data entry skills
• Excellent communication and organizational skills

Preferred

• Ophthalmology or optometry billing experience
• Certified Professional Biller (CPB) or CPC certification
• Experience with EHR/PM systems such as:
  • Modernizing Medicine (ModMed)
• Knowledge of vision plans:
  • VSP
  • EyeMed
  • Superior Vision

Skills & Abilities

• Strong attention to detail
• Ability to multitask and prioritize
• Problem-solving and critical thinking skills
• Ability to work independently and within a team
• Professional phone etiquette and customer service skills
• Knowledge of insurance authorization and eligibility processes

Work Environment

• Office/clinical environment
• Prolonged sitting and computer use
• Frequent phone communication with insurance carriers and patients

Schedule

• Full-time
• Monday–Friday
• Hours: 8am-5pm

Compensation & Benefits

• Competitive pay based on experience
• Health insurance
• Dental Insurance
• Paid time off
• 401K

Performance Expectations

• Maintain timely claim submission standards
• Reduce claim denials and improve collections
• Maintain accuracy in payment posting and account documentation
• Demonstrate professionalism and teamwork
• Protect patient confidentiality and comply with HIPAA guidelines