Billing Specialist

Billing Specialist The Billing Specialist will play a vital role in the financial operations of our ophthalmology practice, ensuring that claims are processed efficiently and patient billing inquiries are handled with care. The role encompasses a range of tasks within the billing department, including medical coding, charge entry, claims submissions, payment posting, accounts receivable follow‑up, reimbursement management, and authorization management. Reports to: Revenue Cycle Manager Key Responsibilities Claims Management: Process accounts receivable (A/R), handle rejected claims, and perform necessary follow‑up to ensure successful claim processing. Follow up on claims using various systems, including Nextech EHR, TriZetto clearinghouse, and others. Prepare and submit clean claims to insurance companies electronically or by paper. Correct and resubmit claims to third‑party payers when needed. Mail appropriate patient contact letters to resolve outstanding claims. Maintain contact with other departments to obtain and analyze patient information for accurate billing documentation. Respond to patient inquiries and billing concerns via phone, email, and messaging portals. Perform follow‑up calls and written correspondence to patients and payers as needed. Prepare, review, and send patient statements as necessary. Obtain and verify insurance authorizations and pre‑certifications for procedures and services. Ensure all necessary authorizations are secured prior to patient appointments and procedures. Track authorization expirations and follow up on renewals as needed. Communicate with patients and insurance companies to resolve authorization issues or delays. Identify and resolve patient billing complaints in a timely manner. Adhere to policies regarding safety, confidentiality, and HIPAA guidelines. Establish and maintain effective working relationships with office staff and doctors, ensuring a collaborative work environment. Qualifications and Requirements Minimum of 2+ years of experience in ophthalmology billing. Knowledge of medical terminology specific to ophthalmology. Proficiency in CPT, HCPCS, and ICD codes related to ophthalmology. High school diploma required; an associate degree is preferred. Skills Ability to work independently with minimal supervision. Strong organizational and time management skills. Detail‑oriented with the ability to manage multiple tasks and meet deadlines. Strong communication skills, with the ability to effectively interact with patients and office staff. Resourceful, result‑driven, and a team player. Work Environment Hybrid position with the ability to be on‑site for meetings, training, or other work‐related functions. The position may also require on‑site job responsibilities that require being in the office once a week. Monday through Friday, 8:00 AM to 5:00 PM. On‑site work requirement for the initial 90‑day probationary period. Compensation Range: $23.00–$30.00 per hour. Pay: $23.00–$30.00 per hour. Expected hours: 40 per week. Benefits 401(k) 401(k) matching Dental insurance Employee assistance program Health insurance Life insurance Paid time off Tuition reimbursement Vision insurance Schedule 8 hour shift Day shift Monday to Friday Experience ICD-10: 2 years (Required) Ability To Commute Poway, CA (Required) Work Location: Hybrid Note: The content of this job description is intended to provide a general overview of the job's key responsibilities and qualifications. Additional responsibilities may be assigned to meet practice needs. #J-18808-Ljbffr