RCM Specialist (Ophthalmology)

Center for Sight Las Vegas•Las Vegas, MD

About The Position

The Ophthalmology Surgical Coder & Accounts Receivable Specialist is responsible for accurately coding and posting ophthalmic surgical procedures while managing assigned insurance payer accounts receivable to ensure timely, accurate, and compliant reimbursement. This position reviews operative documentation to assign appropriate CPT, ICD-10-CM, HCPCS, and modifier coding, prepares and submits clean claims, investigates and resolves unpaid, underpaid, denied, or delayed claims for assigned payers, and maintains accurate account documentation throughout the revenue cycle. The ideal candidate demonstrates strong analytical skills, attention to detail, and a commitment to coding accuracy, regulatory compliance, and maximizing reimbursement while collaborating with physicians, clinical staff, insurance carriers, and the Revenue Cycle Manager to support operational initiatives, process improvements, and other revenue cycle responsibilities as needed.

Requirements

Minimum three years of medical billing or accounts receivable experience.
Minimum two years of medical coding experience, including surgical coding.
Working knowledge of CPT, ICD-10-CM, HCPCS Level II, and modifier assignment.
Experience interpreting operative reports and physician documentation.
Appeals and denial management
Knowledge of Medicare, Medicaid, commercial insurance, managed care, and payer reimbursement methodologies.
Experience with electronic health records (EHR) and practice management systems.
Strong analytical, organizational, and problem-solving skills.
Excellent written and verbal communication skills.
Proficiency in Microsoft Outlook, Word, and Excel.

Nice To Haves

Ophthalmology coding and billing experience.
Certified Professional Coder (CPC), Certified Professional Biller (CPB), Certified Ophthalmic Coding Specialist (COCS), or equivalent certification
Experience with ModMed (Modernizing Medicine).

Responsibilities

Review operative reports and physician documentation to assign accurate CPT, ICD-10-CM, HCPCS, and modifier coding.
Accurately code ophthalmology surgical procedures in accordance with AMA, CMS, AAO, NCCI, and payer-specific guidelines.
Post surgical cases into the practice management system within established departmental turnaround times.
Support all phases of the revenue cycle, including registration, insurance verification, referrals, authorizations, charge capture, coding, billing, payment posting, accounts receivable, patient collections, and denial management.
Monitor aging reports and prioritize accounts based on timely filing limits, aging, financial impact, and payer requirements.
Review claim status through payer portals, clearinghouses, and direct communication with insurance carriers.
Investigate unpaid, denied, rejected, and underpaid claims.
Identify barriers preventing reimbursement and take appropriate corrective action; Escalate complex reimbursement issues to leadership when appropriate.
Submit corrected claims, appeals, reconsiderations, and supporting documentation as necessary.
Maintain current knowledge of coding guidelines, payer regulations, and revenue cycle best practices through ongoing education.
Assist with special projects, reporting, and operational initiatives as assigned by the Revenue Cycle Manager.