Essential Responsibilities:

Manage insurance claim submissions, payment posting, and accounts receivable follow-up. Investigate, resolve, and appeal denied or underpaid medical claims with commercial insurers, Medicare, and Medicaid. Prepare and submit comprehensive first-level and second-level appeals, including supporting medical documentation and payer-specific requirements. Monitor payer trends and identify root causes of claim denials to improve clean claim rates. Obtain and manage prior authorizations for buy-and-bill medications and procedures, including retina pharmaceuticals such as anti-VEGF injections. Verify insurance benefits and coverage for specialty medications and procedures. Communicate with physicians, technicians, and clinical staff to obtain documentation necessary for claims and appeals. Maintain accurate documentation of payer communications and authorization status. Monitor aging reports and prioritize high-dollar outstanding accounts. Stay current on CPT, ICD-10-CM, HCPCS, Medicare, and commercial payer billing guidelines. Assist with revenue cycle improvement initiatives and workflow optimization. Qualifications Minimum of 2 years of medical billing experience, preferably in ophthalmology or retina.

Strong experience with:

Insurance claim denials and denial management Medical necessity appeals Buy-and-bill prior authorizations Medicare and commercial insurance billing Accounts receivable follow-up Working knowledge of CPT, ICD-10-CM, HCPCS, and modifier usage. Experience with electronic medical records (EMR) and practice management software. Excellent analytical, organizational, and problem-solving skills. Strong written and verbal communication skills. Ability to work independently while managing multiple priorities.

Preferred Qualifications:

Retina or ophthalmology billing experience. Experience with specialty pharmaceutical reimbursement and buy-and-bill workflows. Knowledge of anti-VEGF medications and payer coverage requirements. Certified Professional Biller (CPB) or Certified Professional Coder (CPC) certification is a plus.

We Offer:

Competitive salary based on experience Comprehensive benefits package Paid time off and holidays Retirement plan with employer contribution Professional development opportunities Supportive, team-oriented work environment If you are detail-oriented, enjoy solving complex reimbursement challenges, and have a passion for maximizing revenue through effective denial management and prior authorization expertise, we encourage you to apply.

Pay:

From $24.13 per hour

Benefits:

401(k) 401(k) matching Dental insurance Employee discount Flexible spending account Health insurance Life insurance Paid time off Retirement plan Vision insurance

Work Location:

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