Medical Biller - Billing and Compliance Representative

Eyesight Ophthalmic Services - Somersworth, NH

Full-time

Somersworth, NH

Ambulatory Health Care Services

About the position

The Medical Biller/Billing and Compliance Representative is responsible for managing complex billing processes to ensure accurate claims and optimize revenue. This role requires specialized knowledge of ophthalmic billing, coding, and compliance, and involves collaboration with clinical and administrative teams to support the financial goals of Eyesight Ophthalmic Services.

Responsibilities

• Analyze current billing processes and identify areas for improvement to enhance efficiency, accuracy, and overall revenue cycle management.
• Responsible for oversight and optimization of surgery posting protocols to improve workflow efficiency.
• Manage the posting of electronic funds transfer (EFTs) and other payments to patient accounts ensuring all payments are recorded accurately and timely.
• Ensure compliance with ophthalmology specific coding guidelines including HIPAA, CPT, ICD-10, and maintain awareness of changes in regulations (e.g. MIPS).
• Manage the annual setup and continuous updates of fee schedules in EMA, ensuring accuracy and alignment with payer guidelines, and collaborate with the billing team to maintain efficient operations.
• Generate regular billing and financial reports for management, providing insights into revenue trends, payer performance, A/R status, and billing department effectiveness.
• Stay current on prior authorization requirements/processes and ensure timely and accurate submission of prior authorization requests.
• Remain up to date with industry changes, including updates to Medicare and Medicaid billing guidelines.
• Work closely with Surgical Coordinators and clinical staff to verify all necessary documentation is complete and accurate for billing purposes.

Requirements

• High School graduate or GED is required.
• 1 year in an office setting.

Nice-to-haves

• Experience working in a medical office.
• Understanding of Ophthalmic language and terms.
• Financial experience in bookkeeping, receivables, and payables.
• Proficiency in billing software and EHR systems.