Retina Consultants of San Diego
Billing Specialist
The Billing Specialist will play a vital role in the financial operations of our ophthalmology practice, ensuring that claims are processed efficiently and patient billing inquiries are handled with care. The role encompasses a range of tasks within the billing department, including medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, reimbursement management, and authorization management.
Reports to:
Revenue Cycle Manager
Key Responsibilities
Claims Management:
Work on accounts receivable (A/R), process rejected claims, and perform necessary follow-up to ensure successful claim processing.
Follow up on claims using various systems, including Nextech EHR, TriZetto clearinghouse, and others.
Prepare and submit clean claims to insurance companies electronically or by paper.
Correct and resubmit claims to third‑party payers when needed.
Mail appropriate patient contact letters to resolve outstanding claims.
Billing Operations:
Maintain contact with other departments to obtain and analyze patient information for accurate billing documentation.
Respond to patient inquiries and billing concerns via phone, email, and messaging portals.
Perform follow‑up calls and written correspondence to patients and payers as needed.
Prepare, review, and send patient statements as necessary.
Authorization Management:
Obtain and verify insurance authorizations and pre‑certifications for procedures and services.
Ensure all necessary authorizations are secured prior to patient appointments and procedures.
Track authorization expirations and follow up on renewals as needed.
Communicate with patients and insurance companies to resolve authorization issues or delays.
Customer Service & Compliance:
Identify and resolve patient billing complaints in a timely manner.
Adhere to policies regarding safety, confidentiality, and HIPAA guidelines.
Establish and maintain effective working relationships with office staff and doctors, ensuring a collaborative work environment.
Qualifications and Requirements
Minimum of 2+ years of experience in ophthalmology billing.
Knowledge of medical terminology specific to ophthalmology.
Proficiency in CPT, HCPCS, and ICD codes related to ophthalmology.
High school diploma required; an associate degree is preferred.
Skills
Ability to work independently with minimal supervision.
Strong organizational and time management skills.
Detail‑oriented with the ability to manage multiple tasks and meet deadlines.
Strong communication skills, with the ability to effectively interact with patients and office staff.
Resourceful, result‑driven, and a team player.
Work Environment
Hybrid position with the ability to be on‑site for meetings, training, or other work‑related functions.
Monday through Friday, 8:00 AM to 5:00 PM.
Compensation Range $23.00 – $30.00 per hour
Benefits
401(k) and 401(k) matching
Dental insurance
Employee assistance program
Health insurance
Life insurance
Paid time off
Tuition reimbursement
Vision insurance
Schedule
8 hour shift
Day shift
Monday to Friday
Location Poway, CA – Hybrid
EEO Statement: This is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic.
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Reports to:
Revenue Cycle Manager
Key Responsibilities
Claims Management:
Work on accounts receivable (A/R), process rejected claims, and perform necessary follow-up to ensure successful claim processing.
Follow up on claims using various systems, including Nextech EHR, TriZetto clearinghouse, and others.
Prepare and submit clean claims to insurance companies electronically or by paper.
Correct and resubmit claims to third‑party payers when needed.
Mail appropriate patient contact letters to resolve outstanding claims.
Billing Operations:
Maintain contact with other departments to obtain and analyze patient information for accurate billing documentation.
Respond to patient inquiries and billing concerns via phone, email, and messaging portals.
Perform follow‑up calls and written correspondence to patients and payers as needed.
Prepare, review, and send patient statements as necessary.
Authorization Management:
Obtain and verify insurance authorizations and pre‑certifications for procedures and services.
Ensure all necessary authorizations are secured prior to patient appointments and procedures.
Track authorization expirations and follow up on renewals as needed.
Communicate with patients and insurance companies to resolve authorization issues or delays.
Customer Service & Compliance:
Identify and resolve patient billing complaints in a timely manner.
Adhere to policies regarding safety, confidentiality, and HIPAA guidelines.
Establish and maintain effective working relationships with office staff and doctors, ensuring a collaborative work environment.
Qualifications and Requirements
Minimum of 2+ years of experience in ophthalmology billing.
Knowledge of medical terminology specific to ophthalmology.
Proficiency in CPT, HCPCS, and ICD codes related to ophthalmology.
High school diploma required; an associate degree is preferred.
Skills
Ability to work independently with minimal supervision.
Strong organizational and time management skills.
Detail‑oriented with the ability to manage multiple tasks and meet deadlines.
Strong communication skills, with the ability to effectively interact with patients and office staff.
Resourceful, result‑driven, and a team player.
Work Environment
Hybrid position with the ability to be on‑site for meetings, training, or other work‑related functions.
Monday through Friday, 8:00 AM to 5:00 PM.
Compensation Range $23.00 – $30.00 per hour
Benefits
401(k) and 401(k) matching
Dental insurance
Employee assistance program
Health insurance
Life insurance
Paid time off
Tuition reimbursement
Vision insurance
Schedule
8 hour shift
Day shift
Monday to Friday
Location Poway, CA – Hybrid
EEO Statement: This is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic.
#J-18808-Ljbffr