Ophthalmology Coding Auditor

We are seeking a detail-oriented, on-site Ophthalmology Coding Auditor to join our premier private practice. Under direct supervision of the Billing Manager, the Coding Auditor audits ophthalmology and optometry medical records for compliance with federal coding regulations and guidelines. Successful candidates will have extensive knowledge of auditing and education on CPT, ICD-10, and HCPCS codes and guidelines. In this role, you will work directly alongside our clinic team to review clinical documentation, surgical charts, and diagnostic reports, ensuring accurate coding, regulatory compliance, and optimal reimbursement. You will serve as our internal expert, identifying billing risk areas and providing face-to-face feedback and education to our providers and staff to support the financial health of our practice.

 Key Responsibilities

 Perform On-Site Audits: Conduct regular retrospective and prospective reviews of clinical charts, including complex surgical procedures (e.g., cataracts, vitrectomies, glaucoma surgeries) and diagnostic testing (OCT, visual fields, fundus photography).

1. Verify Compliance: Ensure all documentation meets CMS, OIG, local coverage determinations (LCDs), and private payer guidelines.
2. Identify Code Accuracy: Validate the appropriate application of ICD-10-CM, CPT, HCPCS, and ophthalmology-specific E/M or Eye Codes (92002-92014), including accurate modifier usage (e.g., RT, LT, 50, 25, 57).
3. Provider & Staff Education: Deliver direct, targeted feedback and training to our ophthalmologists, optometrists, technicians, and scribes to improve real-time documentation quality.
4. Mitigate Risk: Identify billing vulnerabilities, unbundling practices, and under-coding trends to protect the private practice against external audits and financial loss.
5. Medical Records Requests:

• Reviews medical records as directed by Billing for insurance requests and audits.
• Handle all patient medical records request with approval from each applicable doctor.

1. Collaborate Daily: Partner closely with our on-site billing, denials, and practice management teams to resolve complex claim rejections and streamline workflows.
2. Other Duties: Perform other duties as directed by the Billing Manager

 Qualifications & Skills

 Experience: Minimum of 3–5 years of healthcare coding experience, with at least 2 years specializing specifically in ophthalmology or optometry coding and auditing. Ophthalmic technician experience a must.

1. Certifications (Required): Active credential from AAPC or AHIMA, such as:

• Certified Professional Coder (CPC)
• Certified Professional Medical Auditor (CPMA)
• Certified Coding Specialist (CCS)
• Specialized credentials like Certified Ophthalmology Coder (COCC) are highly preferred.

1. Technical Skills: Proficiency with computers, Word Office, and strong knowledge of working with Electronic Health Records (EHRs).
2. Knowledge Base: Expert understanding of CCI edits, medical necessity requirements, global surgical packages, and professional fee billing.
3. Communication: Strong interpersonal skills to build trust and effectively communicate audit findings directly to physicians in a private practice setting. Must have the ability to work independently.
4. Education: High school diploma (or equivalent) required; Associate's or Bachelor's degree in Health Information Management (HIM) is highly preferred.

 Work Environment & Schedule:

o   Location: Fully on site in our Milford, CT Location. (Non-remote, Non-hybrid)

o   Schedule: Full-time, Monday through Friday, 8 to 5, 1 hour lunch, no weekends

o   Benefits: PTO, Health insurance, 401k

 Salary Range: $22.00-$27.00 per hour