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Job DescriptionSalary: 18-23 The Ophthalmic Billing & E/M Coding Specialist is responsible for accurately posting clinic and hospital charges, with a primary focus on ophthalmologyrelated Evaluation & Management (E&M) coding. This role includes reviewing documentation from ophthalmologists, ensuring correct use of CPT and ICD10 codes specific to ophthalmic services, drafting appeals for denied claims, assisting patients with understanding their accounts, and payment posting. Essential Job Functions • Accounts Receivable (A/R):Monitor and follow up on aging reports to reduce outstanding, delinquent balances for both patients and insurance., • Denial Management: Review and appeal denied rejected claims communicating directly with insurance payers., • Verify coding accuracy by reviewing provider documentation against ophthalmologyspecific coding guidelines, payer rules, and reference materials., • Communicate with providers when documentation, dictation, or coding information is missing or unclear., • Meet regularly with the Billing Supervisor to review and resolve coding questions, documentation issues, and payerspecific challenges., • Draft wellsupported appeal letters to insurance carriers for denials related to coding, documentation, or medical necessity, especially for ophthalmic services and diagnostic testing. Patient Inquiries:Resolve patient billing questions, manage account statements, and collect payments. * Claims Submission:Electronically submit claims to insurance carriers, ensuring accurate coding for ophthalmology-specific procedures (e.g., cataract surgery, injections, OCT scans). • Payment Posting:Accurately post payments from insurance (ERAs/EOBs) and patients to their respective accounts., • Compliance:Ensure all billing activities adhere to HIPAA regulations and specific payer guidelines., • Participate in staff meetings and continuing education, including ophthalmologyspecific coding updates and compliance training., • Promote clear and professional communication with clinical staff, providers, and coworkers., • Aid coworkers and support team workflows as needed., • Maintain a safe, organized, and clean work environment. To perform this role successfully, individuals must be able to perform each essential function satisfactorily. Reasonable accommodation may be provided for individuals with disabilities. • Minimum of a high school diploma or equivalent., • 2-5 years of medical billing experience, with preference for ophthalmology or surgical specialties., • Proficiency in CPT, ICD-10, and modifiers, specifically regarding global surgery policies. Familiarity with surgical billing, global periods, and Medicare/Medicaid/Medi-Cal rules., • Vast knowledge of Medical terminology.1, • Strong interpersonal skills, with the ability to communicate clearly and professionally with physicians and staff., • Experience with EMR/billing systems such as Practice +, MoD MED, TriZetto, and Availity., • Excellent organizational skills and a high level of accuracy, especially in reviewing documentation and entering charges., • Strong attention to detail, analytical skills, and communication capabilities for handling patient and payer inquiries., • Ability to read and create reports, checklists, and correspondence, and to understand complex written instructions. Excel knowledge a plus., • Strong analytical skills with the ability to perform calculations and review detailed coding data quickly and accurately., • Ability to apply common sense and sound judgment to resolve routine problems based on standardized procedures., • Must be a self-motivated multi-tasker., • Bi-Lingual is a plus

Job Description ESSENTIAL FUNCTIONS • Abstracts data in compliance with national, regional, and local policies, and interprets and reviews medical record documentation to assign accurate ICD-10 diagnosis and CPT procedure codes., • Utilizes practice management system (PMS) to accurately account for demographics and services performed for all scheduled and unscheduled surgical cases according to standard procedures and coding guidelines., • Utilizes individual hospital medical record systems and coordinates with physicians and staff to obtain clinical documents and demographics required for appropriate coding and billing for all hospital procedures., • High school diploma/GED or equivalent working knowledge preferred., • At least three years of experience in provider coding and medical terminology with extensive knowledge of ICD-10, CPT, and HCPC coding required., • A minimum of one of the following credentials: CCS-P or CPC., • Meets established coding and abstracting quality and productivity standards., • Experience with various coding software. Previous experience with remote coding is preferred. Possesses PC skills, both keyboarding and applications., • Requires a good understanding of anatomy, physiology, medical terminology, and disease processes., • Ability to work independently., • Demonstrates knowledge of sequencing diagnoses and procedure codes outlined in the ICD-10-CM Official Coding Guidelines, Uniform Hospital Discharge Data Set, CMS guidelines, and other resources as applicable., • Knowledge of government and commercial insurance plans requirements., • Skill in customer service and an understanding of The HOPCo code of conduct and culture., • Skill in communicating effectively with physicians, clinical staff, and the public., • Ability to maintain patient confidentiality., • Ability to communicate with internal and external customers professionally., • Requires sitting and standing associated with a normal office environment., • Some bending and stretching are required.

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