Full Time
Professional Billing LLC
Hybrid (Plymouth, MI, USA)
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...