Ophthalmology Billing Specialist (AAPC Certified)

Job Summary:
The Ophthalmology Billing Specialist plays a key role in managing the full revenue cycle process for eye care providers. The ideal candidate has a strong background in medical billing with AAPC certification (CPB, CPC, or equivalent) and a specific understanding of ophthalmology-related procedures, modifiers, payer policies, and coding guidelines.

Key Responsibilities:
• Submit accurate and timely ophthalmology claims to Medicare, Medicaid, and commercial payers via electronic and paper submission.
• Apply appropriate coding (CPT, ICD-10, HCPCS) for ophthalmology services, including office visits, diagnostic testing (OCT, visual fields, fundus photography), minor and major surgical procedures (e.g., cataract surgery, laser procedures).
• Utilize ophthalmology-specific modifiers (e.g., -RT/-LT, -51, -25, -59, -24, -78, -79) accurately.
• Review and correct claim denials or rejections; follow up with insurance companies to resolve unpaid claims.
• Post insurance and patient payments; handle payment discrepancies and perform account reconciliation.
• Work with ophthalmology practice staff and physicians to clarify documentation or coding issues.
• Maintain compliance with HIPAA regulations, CMS guidelines, and payer-specific ophthalmology billing requirements.
• Keep current with coding changes, payer updates, and ophthalmology billing best practices.

Requirements:
• AAPC Certification (CPB, CPC, or equivalent) required.
• Minimum 2 years of billing experience, with at least 1 year in ophthalmology or optometry billing.
• Proficient in ophthalmology-specific coding, terminology, and services (routine eye exams, refractions, injections, surgeries, etc.).
• Familiarity with common ophthalmic procedures (e.g., cataract surgery, YAG laser, intravitreal injections).
• Strong understanding of insurance guidelines, including vision plans (VSP, EyeMed) vs. medical billing.
• Experience with billing software EHRs (NexTech, Compulink, Modernizing Medicine, EyeMD), and PM’s (eThomas, Compulink, NexTech, Open Practice).
• Excellent communication skills and attention to detail.

Preferred Qualifications:
• Experience with vision and medical billing crosswalks and coordination of benefits.
• Basic knowledge of ASC (Ambulatory Surgery Center) and Outpatient Hospital billing for ophthalmology procedures.
• Understanding of global periods, surgical packages, and bundled services.