Ophthalmic Billing Specialist

Ennen Eye Center•Fort Smith, AR

4d•Onsite

About The Position

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. The ideal candidate is detail-oriented, organized, knowledgeable in medical insurance, and able to work efficiently in a fast-paced clinical environment.

Requirements

High school diploma or equivalent
Minimum 1–2 years of medical billing experience
Knowledge of CPT, ICD-10, and insurance claim processing
Experience with commercial insurance, Medicare, and Medicaid
Strong computer and data entry skills
Excellent communication and organizational skills

Nice To Haves

Ophthalmology or optometry billing experience
Certified Professional Biller (CPB) or CPC certification
Experience with EHR/PM systems such as: Modernizing Medicine (ModMed)
Knowledge of vision plans: VSP EyeMed Superior Vision
Strong attention to detail
Ability to multitask and prioritize
Problem-solving and critical thinking skills
Ability to work independently and within a team
Professional phone etiquette and customer service skills
Knowledge of insurance authorization and eligibility processes

Responsibilities

Submit electronic and paper claims accurately and timely
Review claims for coding accuracy and completeness prior to submission
Correct and resubmit denied or rejected claims
Monitor claim status and follow up with insurance carriers
Verify payer requirements and filing deadlines
Post insurance and patient payments accurately
Reconcile daily deposits and payment batches
Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs)
Identify and resolve payment discrepancies
Investigate denied, underpaid, or unpaid claims
Appeal denied claims when appropriate
Work aging accounts receivable reports
Maintain acceptable A/R benchmarks and reduce outstanding balances
Bill routine vision and medical eye care services
Understand modifiers, diagnosis coding, and ophthalmic procedures
Process claims for: Cataract surgery, Premium lenses, Injections, Diagnostic testing, Office visits, Refractions, Optical-related charges as applicable
Answer patient billing questions professionally
Review patient balances and payment arrangements
Assist with estimates and insurance benefit explanations
Maintain confidentiality regarding all patient financial information
Maintain HIPAA compliance at all times
Stay current on insurance regulations and billing updates
Document account activity thoroughly and accurately
Follow practice policies and procedures