Certified Billing and Coding Specialist, Ophthalmology Position Available In Middlesex, Massachusetts

Certified Billing and Coding Specialist, Ophthalmology Valley Eye Physicians & Surgeons Ayer, MA 01432 • Hybrid work

Job Description:

Located in Central Massachusetts, our client is a well-established ophthalmology practice, seeking a highly skilled and experienced Certified Billing and Coding Specialist to join the revenue cycle team. This role requires knowledge of billing and coding (ophthalmic preferred), strong technical aptitude with EHR systems, and a proven ability to oversee the billing component of accounts from start to finish. The ideal candidate will be a strategic thinker with hands-on expertise, capable of identifying issues proactively and driving workflow improvements that enhance revenue capture and operational efficiency.

Position Overview:

Supervised by the Billing Manager, the individual will be responsible for obtaining appropriate insurance authorizations, referrals and payments for all patient visits and procedures as well as collection of patient service coinsurance, deductibles and self-pay revenue for our client. Job functions include charge capture, coding, claim submission, account follow-up, payment reconciliation, and denial management.

Core Responsibilities:

Coding and Documentation Compliance Review clinical and surgical documentation for accuracy and completeness Ensure coding and documentation meet CMS, payer-specific, and specialty-specific guidelines. Collaborate with physicians and clinical staff to ensure completeness and clarity of documentation. Stay updated on industry changes, local coverage determinations (LCDs), and NCCI edits. Authorization and Referrals Coordinate and track prior authorizations for diagnostic tests, surgical procedures, and high-cost medications. Verify medical necessity documentation and obtain supporting clinical records for submissions. Process and manage referrals in compliance with payer and network requirements. Communicate authorization outcomes to patients and clinical staff to support scheduling and care continuity. Patient and Insurance Account Management Oversee accurate charge entry, claims submission, and payment posting. Work denials and rejections to ensure timely resolution and appeal when appropriate. Assist patients with account inquiries, statement clarification, and financial responsibility education. Monitor patient balances, establish payment plans, and escalate delinquent accounts when necessary. Technical and Analytical Responsibilities Comfortable and familiar with electronic health record (EHR) and practice management systems; experience with Modernizing Medicine (EMA) is preferred. Utilize payer portals and clearinghouses to manage eligibility, claim status, remittances, and appeals. Compliance and Payer Relations Ensure adherence to HIPAA and payer-specific compliance regulations. Maintain and submit documentation required for audits and credentialing purposes. Manage appeals and denial resolution process with detailed documentation and effective communication with payers. Participate in compliance training, policy updates, and payer education sessions. Ensure strict adherence to HIPAA guidelines and safeguard all protected health information (PHI). Other duties, including ad-hoc projects, as assigned.

Qualifications:

Certified Professional Coder (CPC) or Certified Ophthalmic Coder (COC) required; other specialty-specific certifications a plus Customer service experience, required Two-year college degree, preferred 1-3 years’ experience in health care setting and extensive knowledge of 3rd party payers and billing requirements, preferred

Preferred Skills:

Experience with appeals and complex surgical coding Familiarity with Medicare Advantage and commercial payer policies Intermediate knowledge of third-party payers Excellent interpersonal skills, written and oral communication skills Accuracy, with attention to detail Ability to work both independently and as part of a team Ability to work under pressure, multi-task and meet deadlines

Compensation:

Competitive salary commensurate with experience, plus benefits (health, dental, retirement, PTO).

Work Environment and Benefits:

Interested candidates should submit a resume for consideration. The position is full-time, with competitive pay and benefits commensurate with experience. This position may be on-site, hybrid, or remote.

Job Type:

Full-time Pay:

$20.00 – $24.00 per hour Expected hours: 40 per week

Schedule:

Monday to Friday Ability to

Commute:

Ayer, MA 01432 (Required) Ability to

Relocate:

Ayer, MA 01432: Relocate before starting work (Required)

Work Location:

Hybrid remote in Ayer, MA 01432