Billing Specialist Ophthalmology

Billing Specialist Ophthalmology Eye Care Specialists - 3.8 Milwaukee, WI Job Details Full-time From $21 an hour 17 hours ago Benefits Health insurance 401(k) Paid time off Qualifications Teamwork Medicare Interpersonal skills Ophthalmology Certified Professional Coder CMS regulatory compliance Charge capture (medical billing) Medicare regulations Attention to detail Centers for Medicare and Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS) billing regulations Medicaid regulations Medicaid Time management Full Job Description Position Summary The Ophthalmology Billing Specialist is responsible for accurate, timely, and compliant billing operations for a Medicare- and Medicaid-heavy, surgical-focused ophthalmology practice with three onsite clinic locations. This role requires advanced experience in high-volume charge entry and charge capture, with the ability to support payment posting functions as needed. The ideal candidate has hands-on experience in ophthalmology billing workflows, strong Medicare and Medicaid payer rules, and demonstrated proficiency using practice management and electronic medical records platforms. Key Responsibilities Charge Entry & Charge Capture (Primary Responsibility) Perform high-volume charge entry for ophthalmology services, including clinic visits, diagnostic testing, and surgical procedures Ensure complete and accurate charge capture from EyeMD clinical documentation, operative reports, and surgical schedules Enter professional and technical charges accurately across three onsite clinic locations Apply correct CPT, ICD-10, modifiers, and global surgery rules in accordance with Medicare and Medicaid billing requirements Validate documentation supports billed services prior to submission Identify and resolve missing, incomplete, or inconsistent charge information through direct communication with clinical staff Ophthalmology Coding & Medicare Compliance Apply ophthalmology-specific coding knowledge for office visits, diagnostic tests, injections, lasers, and surgical procedures Ensure compliance with Medicare and Medicaid regulations, NCCI edits, LCD/NCD requirements, and payer-specific guidelines Identify and correct coding or charge discrepancies prior to claim submission Stay current with ophthalmology coding updates, Medicare policy changes, and payer requirements Payment Posting (Secondary / As Needed) Accurately post insurance and patient payments, adjustments, and contractual write-offs Review EOBs/ERAs for accuracy and identify underpayments or posting variances Escalate payment discrepancies or denial trends to leadership for follow-up Systems & Workflow Support Utilize Medics Premier for billing, charge entry, and payment posting workflows Navigate EyeMD to review clinical documentation and validate charge accuracy Support consistent billing workflows across three clinic locations Collaborate with revenue cycle leadership to improve charge capture accuracy and efficiency Collaboration & Communication Work onsite with physicians, technicians, and administrative staff to support accurate billing Serve as a resource for charge capture questions and documentation requirements Communicate clearly and professionally with internal teams regarding billing issues Qualifications Required Minimum of 1 year of ophthalmology billing experience Extensive experience in high-volume charge entry and charge capture Strong working knowledge of Medicare billing , global surgery rules, and ophthalmology procedures Experience working in a surgical-heavy ophthalmology practice Preferred 3+ years of ophthalmology billing experience. Hands-on experience using Medics Premier and EyeMD Coding certification (CPC, COC, or equivalent) - strongly preferred Experience with payment posting and reconciliation Experience supporting multi-provider practices Skills & Competencies Exceptional attention to detail and accuracy Ability to manage high-volume workloads and meet deadlines Strong analytical and problem-solving skills Excellent organizational and time-management skills Clear verbal and written communication Ability to work independently while supporting a collaborative team environment Work Environment Onsite role supporting three ophthalmology clinic locations Fast-paced, Medicare- and Medicaid-driven, surgical-focused practice Deadline-oriented revenue cycle environment Physical & Technical Requirements Prolonged periods of computer and data-entry work Ability to work accurately with detailed financial and clinical documentation

Job Type:

Full-time Pay:

From $21.00 per hour

Benefits:

401(k) Health insurance Paid time off

Work Location:

In person