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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 Ophthalmic Billing Specialist is responsible for managing the medical billing process for an eye care practice, including ophthalmology and optometry services.

<h1>Position Summary</h1><p>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.</p><p>The ideal candidate is detail-oriented, organized, knowledgeable in medical insurance, and able to work efficiently in a fast-paced clinical environment.</p><p> </p><h1>Essential Duties & Responsibilities</h1><h3>Insurance & Claims Processing</h3><ul><li>Submit electronic and paper claims accurately and timely</li><li>Review claims for coding accuracy and completeness prior to submission</li><li>Correct and resubmit denied or rejected claims</li><li>Monitor claim status and follow up with insurance carriers</li><li>Verify payer requirements and filing deadlines</li></ul><h3>Payment Posting & Reconciliation</h3><ul><li>Post insurance and patient payments accurately</li><li>Reconcile daily deposits and payment batches</li><li>Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs)</li><li>Identify and resolve payment discrepancies</li></ul><h3>Denial & Accounts Receivable Management</h3><ul><li>Investigate denied, underpaid, or unpaid claims</li><li>Appeal denied claims when appropriate</li><li>Work aging accounts receivable reports</li><li>Maintain acceptable A/R benchmarks and reduce outstanding balances</li></ul><h3>Ophthalmology & Optometry Billing</h3><ul><li>Bill routine vision and medical eye care services</li><li>Understand modifiers, diagnosis coding, and ophthalmic procedures</li><li>Process claims for:<ul><li>Cataract surgery</li><li>Premium lenses</li><li>Injections</li><li>Diagnostic testing</li><li>Office visits</li><li>Refractions</li><li>Optical-related charges as applicable</li></ul></li></ul><h3>Patient Financial Services</h3><ul><li>Answer patient billing questions professionally</li><li>Review patient balances and payment arrangements</li><li>Assist with estimates and insurance benefit explanations</li><li>Maintain confidentiality regarding all patient financial information</li></ul><h3>Compliance & Documentation</h3><ul><li>Maintain HIPAA compliance at all times</li><li>Stay current on insurance regulations and billing updates</li><li>Document account activity thoroughly and accurately</li><li>Follow practice policies and procedures</li></ul><p> </p><h1>Qualifications</h1><h2>Required</h2><ul><li>High school diploma or equivalent</li><li>Minimum 1–2 years of medical billing experience</li><li>Knowledge of CPT, ICD-10, and insurance claim processing</li><li>Experience with commercial insurance, Medicare, and Medicaid</li><li>Strong computer and data entry skills</li><li>Excellent communication and organizational skills</li></ul><h2>Preferred</h2><ul><li>Ophthalmology or optometry billing experience</li><li>Certified Professional Biller (CPB) or CPC certification</li><li>Experience with EHR/PM systems such as:<ul><li>Modernizing Medicine (ModMed)</li></ul></li><li>Knowledge of vision plans:<ul><li>VSP</li><li>EyeMed</li><li>Superior Vision</li></ul></li></ul><h1>Skills & Abilities</h1><ul><li>Strong attention to detail</li><li>Ability to multitask and prioritize</li><li>Problem-solving and critical thinking skills</li><li>Ability to work independently and within a team</li><li>Professional phone etiquette and customer service skills</li><li>Knowledge of insurance authorization and eligibility processes</li></ul><hr/><h1>Work Environment</h1><ul><li>Office/clinical environment</li><li>Prolonged sitting and computer use</li><li>Frequent phone communication with insurance carriers and patients</li></ul><hr/><h1>Schedule</h1><ul><li>Full-time</li><li>Monday–Friday</li><li>Hours: 8am-5pm</li></ul><hr/><h1>Compensation & Benefits</h1><ul><li>Competitive pay based on experience</li><li>Health insurance</li><li>Dental Insurance</li><li>Paid time off</li><li>401K</li></ul><hr/><h1>Performance Expectations</h1><ul><li>Maintain timely claim submission standards</li><li>Reduce claim denials and improve collections</li><li>Maintain accuracy in payment posting and account documentation</li><li>Demonstrate professionalism and teamwork</li><li>Protect patient confidentiality and comply with HIPAA guidelines</li></ul><p> </p><p> </p>

Ennen Eye Center

Ophthalmic Billing Specialist

Accounts Receivable

Accounts Receivable Management

Benchmarking

Billing

Cataract

Certified Professional Coder (CPC)

Claims Processing

Communication Skills

Customer Support/Service

Data Entry

Detail Oriented

Documentation

Establish Priorities

HIPAA (Health Insurance Portability and Accountability Act)

Health Insurance

High School Diploma

ICD-10

Injections

Insurance

Insurance Claims

Insurance Documentation

Insurance Regulations

Maintain Compliance

Medicaid

Medical Billing

Medical Record System

Medical Records

Medicare

Medicine

Multitasking

Ophthalmology

Optometry

Organizational Skills

Patient Care Denials

Patient Confidentiality

Payment Posting

Problem Solving Skills

Reconciliation

Time Management

Vision Plan

Talent Acquisition

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Ophthalmic Billing SpecialistEnnen Eye Center

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