Key Responsibilities Perform On-Site Audits:

Conduct regular retrospective and prospective reviews of clinical charts, including complex surgical procedures (e.g., cataracts, vitrectomies, glaucoma surgeries) and diagnostic testing (OCT, visual fields, fundus photography).

Verify Compliance:

Ensure all documentation meets CMS, OIG, local coverage determinations (LCDs), and private payer guidelines.

Identify Code Accuracy:

Validate the appropriate application of ICD-10-CM, CPT, HCPCS, and ophthalmology-specific E/M or Eye Codes (92002-92014), including accurate modifier usage (e.g., RT, LT, 50, 25, 57).

Provider & Staff Education:

Deliver direct, targeted feedback and training to our ophthalmologists, optometrists, technicians, and scribes to improve real-time documentation quality.

Mitigate Risk:

Identify billing vulnerabilities, unbundling practices, and under-coding trends to protect the private practice against external audits and financial loss.

Medical Records Requests:

Reviews medical records as directed by Billing for insurance requests and audits. Handle all patient medical records request with approval from each applicable doctor.

Collaborate Daily:

Partner closely with our on-site billing, denials, and practice management teams to resolve complex claim rejections and streamline workflows.

Other Duties:

Perform other duties as directed by the

Billing Manager Qualifications & Skills Experience:

Minimum of 3-5 years of healthcare coding experience, with at least 2 years specializing specifically in ophthalmology or optometry coding and auditing. o Ophthalmic technician experience a plus. Certifications (Required): Active credential from AAPC or AHIMA, such as: Certified Professional Coder (CPC) Certified Professional Medical Auditor (CPMA) Certified Coding Specialist (CCS) Specialized credentials like Certified Ophthalmology Coder (COCC) are highly preferred.

Technical Skills:

Proficiency with computers, Word Office, and strong knowledge of working with Electronic Health Records (EHRs).

Knowledge Base:

Expert understanding of CCI edits, medical necessity requirements, global surgical packages, and professional fee billing. 5.

Communication:

Strong interpersonal skills to build trust and effectively communicate audit findings directly to physicians in a private practice setting. Must have the ability to work independently. 6.

Education:

High school diploma (or equivalent) required; Associate's or Bachelor's degree in Health Information Management (HIM) is highly preferred.

Work Environment & Schedule:

Location:

Fully on site in our Milford, CT Location o

Schedule:

Full-time, Monday through Friday, 8 to 5, 1 hour lunch, no weekends o

Benefits:

PTO, Health insurance, 401k

Salary Range:

$22.00-$27.00 per hour

Pay:

$22.00 - $27.00 per hour

Benefits:

401(k) Health savings account Paid time off

Work Location:

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