Specialist- Medical Billing
About The Position
The Medical Billing Specialist is responsible for auditing and monitoring submitted insurance claims for vision and medical care services to ensure accuracy, completeness, timely submission, and compliance with payer and billing requirements. This role serves as a key quality-control resource, identifying and resolving billing issues, tracking claim activity, and partnering with internal teams to ensure claims are submitted appropriately and reimbursement opportunities are maximized. The position will also support process improvement initiatives, reporting, special projects, and operational assignments as needed to support the overall goals of the team.
Requirements
- Minimum 3 years of experience in medical billing, claims auditing, revenue cycle management, or vision insurance.
- Strong knowledge of ICD-10 and CPT coding and general insurance billing procedures.
- Experience reviewing and auditing insurance claims for accuracy and compliance.
- Strong analytical, problem-solving, organizational, and follow-up skills with attention to detail.
- Proficient in billing software, payer portals, and EHR or practice management systems.
- Excellent written and verbal communication skills.
- Ability to manage multiple priorities and work effectively in a high-volume environment.
- Ability to work independently while collaborating effectively with internal teams.
Nice To Haves
- Prior experience in optometry or ophthalmology billing.
- Understanding of HIPAA and healthcare data regulations.
- Familiarity with payer-specific rules and portals (e.g., EyeMed, VSP, Davis).
- Experience in claims auditing, quality assurance, revenue cycle management, and process improvement within a high-volume billing environment.
- Certifications such as CPB, CMRS, or CCS.
- Bachelor’s degree.
Responsibilities
- Audit submitted insurance claims for accuracy, completeness, coding integrity, and compliance with payer requirements, including appropriate use of ICD-10, CPT, and HCPCS codes.
- Monitor claim activity, including submission timeliness, denials, rejections, and billing discrepancies, to support timely reimbursement.
- Identify missing, incorrect, or incomplete information and coordinate with the appropriate teams to resolve issues prior to or following claim submission.
- Verify insurance eligibility, benefits, and payer requirements as needed to support accurate claim submission and resolution.
- Track and analyze claim activity, billing trends, reimbursements, and payer performance to identify opportunities for improved claim accuracy and revenue cycle performance.
- Serve as a resource to internal stakeholders regarding insurance billing requirements, claim status, and payer-specific processes.
- Maintain accurate billing documentation and records in accordance with company policies and applicable regulations.
- Ensure timely invoices by validating client data, billing information, and system setup accuracy.
- Participate in process improvement efforts, system implementations, audits, special projects, and development of billing procedures and workflows.
- Assist with payer portal management, research, and other billing-related administrative responsibilities as needed.
- Perform other duties and responsibilities as assigned.
Benefits
- health care
- retirement savings
- paid time off/vacation
- various employee discounts
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
