FULL_TIME

FEED

HOUR

As a senior member of the team, you’ll play a critical role in optimizing revenue cycle performance by: Resolving complex claim edits, rejections, and denials with accuracy and efficiency. In this role, you will be a key contributor to the financial health of the organization, tackling complex billing challenges, supporting team development, and helping ensure a seamless experience for our patients and providers.

Senior Medical Billing Representative Ophthalmic Consultants of Boston (OCB)Be Part of a Team That’s Advancing Vision Care—and the People Behind ItAt Ophthalmic Consultants of Boston (OCB), we don’t just deliver exceptional eye care—we build careers. As a nationally recognized leader in ophthalmology, we are proud to foster a collaborative, growth-focused environment where expertise is valued and professional development is encouraged.We are seeking an experienced and driven Senior Medical Billing Representative to join our Revenue Cycle team. In this role, you will be a key contributor to the financial health of the organization, tackling complex billing challenges, supporting team development, and helping ensure a seamless experience for our patients and providers. This position is fulltime, onsite at our Plymouth, MA location.<hr/><h3>What You’ll Do</h3>As a senior member of the team, you’ll play a critical role in optimizing revenue cycle performance by:<ul><li>Resolving complex claim edits, rejections, and denials with accuracy and efficiency</li><li>Leading advanced A/R follow-up efforts to ensure timely reimbursement</li><li>Analyzing denial trends and implementing proactive solutions</li><li>Writing detailed, effective appeal letters aligned with clinical documentation and payer policies</li><li>Ensuring compliance with timely filing requirements and regulatory standards</li><li>Reviewing and validating patient demographics, insurance details, charges, and coding</li><li>Serving as a subject matter expert for billing processes, coding, and payer requirements</li><li>Collaborating with insurance carriers, patients, physicians, and internal teams to resolve complex inquiries</li><li>Supporting accurate eligibility verification, authorizations, and referral processes</li><li>Reviewing medical records to ensure alignment with medical necessity guidelines</li><li>Identifying workflow improvements to reduce denials and increase efficiency</li><li>Assisting with onboarding, training, and mentoring of new team members</li></ul><hr/><h3>What You Bring</h3>You are a knowledgeable and detail-oriented billing professional who thrives in a fast-paced, high-volume environment and enjoys sharing your expertise with others.<ul><li>Strong knowledge of medical terminology, ICD-10 diagnosis codes, and CPT-4 procedure codes</li><li>Advanced understanding of coding modifiers and their appropriate use</li><li>Several years of experience in medical billing or revenue cycle operations</li><li>Proven expertise in A/R follow-up and denial management</li><li>Deep understanding of insurance eligibility, benefits, and reimbursement processes</li><li>Familiarity with payer medical necessity requirements and billing policies</li><li>Excellent communication and customer service skills</li><li>Strong analytical, organizational, and problem-solving abilities</li><li>High attention to detail and accuracy</li><li>Ability to manage multiple priorities effectively</li><li>Proficiency with Microsoft Office (Word, Excel, Outlook)</li><li>Solid understanding of HIPAA regulations</li><li>College degree preferred</li><li>CPC, COPC, or similar certification preferred</li></ul><hr/><h3>Why Join OCB?</h3>At OCB, your work has purpose. Behind every claim you resolve is a patient receiving life-changing care. We are committed to supporting our employees with opportunities for growth, a team-oriented culture, and the tools needed to succeed.OCB offers industry leading benefits including:<ul><li>Medical & dental insurance (starts on the 1st day of employment!)</li><li>401(k) plan with Company match</li><li>Company paid Life Insurance</li><li>Company paid Long Term Disability</li><li>Eye care discounts</li><li>Generous Paid Time Off and Paid Holidays</li></ul>To learn more about OCB, please visit our website at <a href="http://www.eyeboston.com" rel="nofollow">www.eyeboston.com</a>#seabrighterfuture#OCBjobsPowered by JazzHR

Ophthalmic Consultants of Boston (OCB) was established in 1969 to offer patients the highest quality eye care and laser/surgical treatment. OCB has nine practice locations in the greater Boston area and Cape Cod. In addition, OCB has three affiliated surgery and laser centers. OCB and its affiliates have 350+ employees. The staff of 27 ophthalmologists uses the most advanced diagnostic, laser and surgical techniques available and their level of care has earned Ophthalmic Consultants of Boston a national and international reputation for excellence. 

Ophthalmic Consultants of Boston

Senior Medical Billing Specialist

Accounts Receivable

Analysis Skills

Billing

Clinical Study Publications

Communication Skills

Current Procedural Terminology (CPT)

Customer Support/Service

Dental Insurance

Detail Oriented

HIPAA (Health Insurance Portability and Accountability Act)

Health Insurance

ICD-10

Insurance

Medical Billing

Medical Coding

Medical Records

Medical Terminology

Mentoring

Microsoft Excel

Microsoft Office

Microsoft Outlook

Microsoft Word

Multitasking

Onboarding

Ophthalmology

Organizational Skills

Performance Tuning/Optimization

Problem Solving Skills

Regulations

Reimbursement

Team Building

Team Player

Time Management

Trend Analysis

Workflow Analysis

partner JazzHR

OTHER

UNKNOWN

Assign appropriate codes using International Classification of Disease system (ICD-9) and/or Current Procedural Terminology (CPT) for diagnosis, procedures and services. Responsible for correctly coding claims based on the services a patient receives in order to obtain reimbursement from insurance or government healthcare programs.

Overview:
Join the transformative Southcoast Behavioral Health team and be part of a difference-making journey every day!Southcoast Behavioral Health, located in Dartmouth, Massachusetts, is a premier mental health treatment center with 192 beds. We serve pediatric, adolescent, adult, and geriatric patients, as well as adults with co-occurring mental health and substance use disorders.  Looking for Medical Coder candidates open to PRN shifts!Rates between $35 - 38/hr (depending on experience and education) PURPOSE STATEMENT:Responsible for assigning ICD-9-CM diagnostic and procedural codes to patient accounts.

Responsibilities:
ESSENTIAL FUNCTIONS:<ul><li>Assign appropriate codes using International Classification of Disease system (ICD-9) and/or Current Procedural Terminology (CPT) for diagnosis, procedures and services.</li><li>Responsible for correctly coding claims based on the services a patient receives in order to obtain reimbursement from insurance or government healthcare programs.</li><li>Read and analyze patient records extracting precise information from documentation, test results and reports.</li><li>Request diagnosis from physicians when not recorded on discharge and in cases where information is incomplete.</li><li>Maintain confidentiality regarding patient care information and chart contents.</li><li>Inform administrator of any incongruences noted in the chart record.</li><li>When appropriate clarify diagnosis, conditions and treatment information by working with the physician according to company policy and procedure.</li><li>Process physician reports needed to code appropriately and accurately.</li></ul>OTHER FUNCTIONS: <ul><li>Perform other functions and tasks as assigned.</li></ul>

Qualifications:
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:<ul><li>High school diploma or equivalent required.</li><li>Certificate or associate’s degree in medical coding or related field preferred.</li><li>Two or more years’ of medical billing/collections/coding preferred.</li><li>Strong knowledge of anatomy, physiology and medical terminology required.</li></ul>LICENSES/DESIGNATIONS/CERTIFICATIONS: <ul><li style="margin-bottom:6pt">Medical Coding Certificate preferred.</li></ul> ADDITIONAL REGULATORY REQUIREMENTS:                                                                                                                                                                                  While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.  We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

Southcoast Behavioral Health

Medical Coder

Anatomy

Behavioral Health

Corporate Policies

Credit and Collections

Disease

Documentation

Geriatrics

Government

Healthcare

Healthcare Reimbursement

High School Diploma

ICD-9

ICD-9-CM

Medical Treatment

Patient Care

Patient Confidentiality

Pediatrics

Physiology

Psychiatry and Mental Health

[AW]-iCims

Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making sound clinical decisions without direct on-site supervision. Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income.

YEAR

Overview:
Nurse Practitioner Per DiemThis position covers all zip codes in: Plymouth County, MA ComplexCare Solutions (CCS) specializes in helping those in need by delivering high-value home and virtual assessments for health plans nationwide. We pride ourselves on our member engagement aimed towards evaluating current health status, gaps in care, potential health risks and care management opportunities with a focus on driving better clinical outcomes.   CCS, on behalf of SME Medical Delaware, P.A., is calling on Advanced Practice Providers that are passionate about helping their local communities. We care dearly about those whom we serve, and we need your help to make a difference in the lives of our members. Providers have the opportunity to spend a full hour with these members, which allows them to capture a comprehensive picture of that individual’s personal needs and what is required to keep them in the home and out of the hospital. <div class="x_x_elementToProof">Compensation:<ul><li style="margin:0in">Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income</li><li style="margin:0in">In-home visit rate: $120 - $140 depending on state of residence</li><li style="margin:0in">If available, our telehealth rate is $85 per completed assessment</li></ul></div>Benefit:This position is eligible to participate in a company 401K plan providing the opportunity to save for retirement through employee contributions. New hires will be automatically enrolled in the company 401(k) plan at a 3% contribution rate with the option to opt out.

Responsibilities:
<ul><li>Knowledge of CMS Regulations and NCQA HEDIS Guidelines</li><li>Knowledge of Evidence-based Clinical Practice Standards: American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA), Familiarity with ICD-10 and CPT-4 coding practices</li><li>Complete comprehensive, accurate and thorough review of the assigned member population, including timely completion and submission of all required encounter documentation (paper or electronic)</li><li>Ensure that all pertinent and active medical conditions are documented in the medical record in a manner compliant with CMS/DHHS, Company policy, and client requirements</li><li>Support the physician/patient relationship and ensure timely and adequate communication, documentation of assessment findings, recommendations, need for additional services, emergency services required if necessary and need for follow up and timelines for follow up to primary care provider (PCP) and health plan as required</li><li>Make general recommendations to members intended to improve members' knowledge of their chronic condition(s), such as information concerning recommended testing</li><li>Address and close identified gaps in care (disease-specific or preventive)</li><li>Recognize emergent or urgent situations requiring escalation and take appropriate action as specified in company policies, and as determined by reasonable professional judgment and ethical professional practice standards; and</li><li>Perform, document and communicate results of Point of Care (POC) Testing</li><li>Maintain compliance with Company policies, procedures and mission statement</li><li>Adhere to all confidentiality and HIPAA requirements as outlined within the Company’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position</li><li>Fulfill those responsibilities and/or duties that may be reasonably provided for the purpose of achieving operational and financial success of the Company</li><li>Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function</li><li>On a monthly basis, be available for a minimum of 25 slots of availability per month (approximately 37 hours)</li><li>We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such</li><li>Other duties as assigned</li></ul>

Qualifications:
<ul style="margin-top:0in"><li>Active un-encumbered license to practice nursing</li><li>ANCC or AANP board certification as a Nurse Practitioner in Family, Adult, Gerontology or Emergency Medicine. </li><li>Maintains current CPR certification</li><li>Compliance, prior to hire, with recommended Healthcare Personnel Requirements for vaccinations and preventive testing:</li><li><ul style="margin-top:0in"><li>Hepatitis B</li><li>Influenza</li><li>MMR: Measles, Mumps and Rubella</li><li>Pertussis, Tetanus and diphtheria and acellular pertussis (Tdap)</li><li>Varicella</li><li>Tuberculosis</li></ul></li><li>Home Health exp a plus </li><li>Must be able to effectively communicate with elderly and chronically ill patients and families</li><li>Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial</li><li>Ability to multitask</li><li>Excellent customer service skills</li><li>Bi-lingual or multi-lingual a plus</li><li>Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making sound clinical decisions without direct on-site supervision</li><li>Proficient with computer platforms, electronic health records (EHRs), secure messaging systems, and cloud-based documentation tools</li></ul>This company utilizes E-Verify. ComplexCare Solutions (CCS) is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. By embracing diversity, equity and inclusion we enhance our work environment and drive business success. ComplexCare Solutions (CCS) strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

ComplexCare Solutions

Nurse Practitioner (Per Diem)

American Nurses Credentialing Center (ANCC)

CPR Certification

Cardiology

Centers for Medicare and Medicaid Services (CMS)

Certified Coding Specialist (CCS)

Clinical Outcomes

Clinical Practices/Protocols

Cloud Computing

Computer Skills

Computer Systems

Content Management Systems (CMS)

Department of Health and Human Services

Diabetes

Diversity

Emergency Medicine

Emergency Services

Equal Employment Opportunity (EEO)

Family Nurse Practitioner (FNP)

Health Plan

Healthcare Effectiveness Data and Information Set (HEDIS)

Hepatitis B

Home Care

Hospital

Maintain Compliance

Medicaid

Medical Conditions

Medical Record System

Medicare

Messaging Technology

Multilingual

National Committee for Quality Assurance (NCQA)

Nurse Practitioner

Nursing Credentials

Operations Processes

Patient Assessment

Primary Care

Risk Management

Staff Requirements

Telehealth

Treatment Plan

We’re looking for a knowledgeable, patient-focused professional who thrives in a fast-paced environment and isn’t afraid of high call volumes or complex insurance scenarios. Are you confident discussing insurance, skilled at navigating surgical authorizations, and passionate about helping patients understand their financial responsibility?

<h2>Join the Front Line of Patient Financial Care at Ophthalmic Consultants of Boston ️</h2><h3> Medical Billing Specialist</h3>Are you confident discussing insurance, skilled at navigating surgical authorizations, and passionate about helping patients understand their financial responsibility? We’re looking for a knowledgeable, patient-focused professional who thrives in a fast-paced environment and isn’t afraid of high call volumes or complex insurance scenarios.This isn’t just a billing role — it’s a critical position that ensures patients feel informed, prepared, and supported before their visit or surgery.<hr/><h3> What You’ll Do</h3>You’ll serve as a key liaison between patients and insurance carriers, ensuring clarity, accuracy, and timely collections.Insurance & Authorizations<ul><li>Verify and interpret deductibles, copays, coinsurance, and out-of-pocket maximums</li><li>Secure prior authorizations for surgical and specialty procedures</li><li>Confirm eligibility and surgical claim coverage directly with insurance carriers</li><li>Provide accurate cost estimates for visits, procedures, and surgeries</li></ul>Patient Financial Communication<ul><li>Clearly explain insurance benefits and projected out-of-pocket expenses</li><li>Set confident, professional expectations regarding payment due at time of service</li><li>Discuss outstanding balances and collect payments</li><li>Assist patients with billing statements and claim questions</li></ul>Operations & Documentation<ul><li>Manage high volumes of insurance claims and daily inbound/outbound calls</li><li>Accurately document benefit verifications and patient communications</li><li>Support front desk and billing operations in a high-demand setting</li></ul><hr/><h3> What You Bring</h3><ul><li>3–5 years of experience in medical billing, insurance verification, or healthcare financial counseling</li><li>Proven experience securing surgical prior authorizations</li><li>Strong knowledge of surgical claims and insurance coverage policies</li><li>Confidence in discussing out-of-pocket costs and collecting payments</li><li>Ability to multitask and pivot quickly in a high-volume call center environment</li><li>Exceptional attention to detail and organization</li><li>Professional, empathetic communication skills for sensitive financial conversations</li></ul><hr/><h3> Why You’ll Love It Here</h3>At OCB, we believe financial clarity is part of outstanding patient care. You’ll join a collaborative team that values accuracy, professionalism, and compassion — all while making a real impact on the patient experience.If you’re ready to bring confidence, clarity, and expertise to a vital healthcare role, we’d love to meet you.Apply today and help patients see clearly — financially and clinically.   Powered by JazzHR

Medical Billing Specialist

Call Centers

Call Volume

Cost Estimates

Financial Management

Insurance Claims

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Senior Medical Billing SpecialistOphthalmic Consultants of Boston

Medical CoderSouthcoast Behavioral Health

Nurse Practitioner (Per Diem)ComplexCare Solutions

Medical Billing SpecialistOphthalmic Consultants of Boston

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