Job Title: Ophthalmology Billing Specialist (AAPC Certified)
Location: Plymouth, MI (Hybrid after 3 month on-site training)
Company: Professional Billing LLC
Employment Type: Full-Time
About Us:
Professional Billing LLC is a trusted partner for ophthalmology practices across the country, offering specialized medical billing services with a focus on accuracy, compliance, and maximized reimbursements. Our team understands the unique nuances of eye care billing, from routine vision services to complex surgical procedures. We’re looking for an experienced and certified Ophthalmology Billing Specialist to join our growing team of professionals.
Job Summary:
The Ophthalmology Billing Specialist plays a key role in managing the full revenue cycle process for eye care providers. The ideal candidate has a strong background in medical billing with AAPC certification (CPB, CPC, or equivalent) and a specific understanding of ophthalmology-related procedures, modifiers, payer policies, and coding guidelines.
Key Responsibilities:
• Submit accurate and timely ophthalmology claims to Medicare, Medicaid, and commercial payers via electronic and paper submission.
• Apply appropriate coding (CPT, ICD-10, HCPCS) for ophthalmology services, including office visits, diagnostic testing (OCT, visual fields, fundus photography), minor and major surgical procedures (e.g., cataract surgery, laser procedures).
• Utilize ophthalmology-specific modifiers (e.g., -RT/-LT, -51, -25, -59, -24, -78, -79) accurately.
• Review and correct claim denials or rejections; follow up with insurance companies to resolve unpaid claims.
• Post insurance and patient payments; handle payment discrepancies and perform account reconciliation.
• Work with ophthalmology practice staff and physicians to clarify documentation or coding issues.
• Maintain compliance with HIPAA regulations, CMS guidelines, and payer-specific ophthalmology billing requirements.
• Keep current with coding changes, payer updates, and ophthalmology billing best practices.
Requirements:
• AAPC Certification (CPB, CPC, or equivalent) required.
• Minimum 2 years of billing experience, with at least 1 year in ophthalmology or optometry billing.
• Proficient in ophthalmology-specific coding, terminology, and services (routine eye exams, refractions, injections, surgeries, etc.).
• Familiarity with common ophthalmic procedures (e.g., cataract surgery, YAG laser, intravitreal injections).
• Strong understanding of insurance guidelines, including vision plans (VSP, EyeMed) vs. medical billing.
• Experience with billing software EHRs (NexTech, Compulink, Modernizing Medicine, EyeMD), and PM’s (eThomas, Compulink, NexTech, Open Practice).
• Excellent communication skills and attention to detail.
Preferred Qualifications:
• Experience with vision and medical billing crosswalks and coordination of benefits.
• Basic knowledge of ASC (Ambulatory Surgery Center) and Outpatient Hospital billing for ophthalmology procedures.
• Understanding of global periods, surgical packages, and bundled services.
What We Offer:
• Competitive pay with opportunities for bonuses
• Hybrid work flexibility after successful completion of 3 month on-site training
• Paid AAPC membership renewal and CEU support
• Professional development and mentorship in ophthalmology billing
• A collaborative, supportive, and specialized billing environment
Interested Persons should submit their resumes to info@probillingpbs.com.