Medical Biller
7 days ago
Experienced Medical Biller – Ophthalmology
Location: Remote (U.S. payor experience required)
Schedule: Monday – Friday, 10:00 AM – 6:00 PM EST
Employment Type: Full-time (contract or employee depending on arrangement)
About the Role
We are seeking a highly experienced Medical Biller with extensive ophthalmology billing expertise to join our team. The ideal candidate will have several years of proven success in U.S. medical billing, excellent references, and a strong understanding of insurance payor policies, prior authorizations, and credentialing. This position requires consistent communication, responsiveness, and proactive problem-solving throughout the workday.
Key Responsibilities
- Full-Cycle Ophthalmology Billing
- Manage front- and back-end billing processes: eligibility & benefits verification, charge entry, claim submission, payment posting, appeals, and collections.
- Provide cost estimates to patients for office visits and surgeries.
- Monitor claims to ensure timely submission and payment.
- Insurance & Payor Communication
- Call insurance companies to resolve claim issues, verify coverage, and obtain prior authorizations.
- Handle credentialing and enrollment with new payors as needed.
- Confirm PCP referrals are valid and complete at least 3 days prior to scheduled appointments.
- Surgical & Clinical Coordination
- Prepare and update cost estimates for surgeries.
- Maintain and update surgery grids on Microsoft Teams.
- Track prior authorizations and ensure all documentation is complete before scheduled procedures.
- Compliance & Documentation
- Manage medical record requests and support audits.
- Ensure billing practices comply with U.S. healthcare regulations and ophthalmology-specific coding standards.
- Collaboration & Responsiveness
- Remain available for Google Meet/phone calls during working hours.
- Actively monitor Microsoft Teams and respond promptly to staff questions and requests.
- Work closely with the administrative and clinical teams to ensure smooth revenue cycle management.
Qualifications
- Experience: Minimum 5+ years of U.S. medical billing experience (ophthalmology strongly preferred).
- References: Must provide legitimate professional references.
- Technical Skills: Strong proficiency in EMR/EHR billing systems, payor portals, and claim submission platforms.
- Communication: Fluent in English (spoken and written), with excellent phone etiquette and professional demeanor.
- Technical Setup: Reliable IT system, fast internet connection, and a professional work environment for calls and meetings.
- Knowledge Base: In-depth understanding of U.S. medical billing regulations, ICD-10/CPT codes (especially ophthalmology), insurance benefits, and prior authorization workflows.
Preferred Attributes
- Prior experience with surgical and subspecialty ophthalmology billing.
- Strong organizational skills with attention to detail.
- Ability to work independently while staying responsive to the team.
- Comfortable with real-time problem solving and multitasking in a fast-paced environment.
Compensation
Competitive and commensurate with experience. Details will be discussed during the interview process.
Job Type: Full-time
Pay: ₹80, ₹90,000.00 per month
Benefits:
- Paid time off
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