Job description:

Job Title:

Ophthalmology Insurance & Billing Manager Location:

Greensboro-High Point, NC Area Position Type:

Full-Time Job Summary We are seeking an experienced and strategic Insurance and Billing Manager to lead the revenue cycle and commercial payer relations for our ophthalmology practice in the Greensboro-High Point region. This specialized role requires a candidate who is highly proficient in the Nextech platform and possesses proven experience in insurance contract review and rate negotiations. You will manage daily billing operations, lead a dedicated team, and directly impact the practice's bottom line by maximizing clean-claim rates and securing optimal reimbursement rates with regional insurance networks.

Key Responsibilities Revenue Cycle & Platform Leadership:

Manage the complete lifecycle of insurance claims, denial management, and accounts receivable (A/R) utilizing Nextech as the primary EHR and billing system.

Contract Review & Payer Negotiations:

Evaluate commercial insurance contracts, evaluate fee schedules, and directly lead negotiations to maximize reimbursement rates. Routinely monitor payer policy changes to protect practice revenue.

Ophthalmology Specialization:

Handle complex billing nuances unique to eye care, including surgical global periods, modifiers, diagnostic testing, and medical vs. routine vision plan coordination.

Team Management:

Lead, mentor, and train a team of medical billers and coders. Establish performance benchmarks, conduct audits, and ensure efficient Nextech workflows.

Denial & A/R Analysis:

Analyze billing dashboards and aging reports to identify root causes for claim denials, implementing corrective workflow fixes to maintain a low days in A/R.

Payer Relations & Compliance:

Maintain strong working relationships with regional provider representatives (e.g., BCBSNC, MedCost, UnitedHealthcare) and ensure strict compliance with HIPAA and federal coding standards.

Qualifications & Skills Software Proficiency:

Required 2+ years of direct experience utilizing Nextech software for billing, scheduling, and/or electronic health records.

Contracting Expertise:

Proven track record in analyzing medical fee schedules, reviewing legal contract terms, and executing payer negotiations .

Experience:

Minimum of 3-5 years of medical billing and revenue cycle management experience, with explicit experience in an ophthalmology or optometry setting.

Supervisory Experience:

1-3 years leading or supervising a healthcare billing or collections team.

Coding Knowledge:

Deep understanding of CPT, ICD-10, and HCPCS codes specific to eye care treatments, injections, and surgeries.

Certifications:

Certified Professional Biller (CPB), Certified Coding Specialist (CCS-P), or Certified Medical Reimbursement Specialist (CMRS) is a significant plus. What We Offer Competitive salary commensurate with specialized contracting and software experience. Comprehensive health, dental, and vision insurance benefits. Paid time off (PTO) and 401(k) matching. Professional work environment in a prominent regional practice.

Job Type:

Full-time Work Location:

In person

Job Type:

Full-time Work Location:

In person