Medical Billing and Coding Specialist

PRACTICE OVERVIEW

Bloom Family Eye Surgeons through its owned and affiliated practices is a leading provider of comprehensive medical and surgical eye clinic in Dayton, Ohio. As a physician-led and physician-owned practice, we offer complete medical eye examinations by specialists in the field of ophthalmology, including the diagnosis, management and treatment of eye diseases. Our Optometric Eye Clinic offers the diagnosis, management and treatment of a wide range of eye diseases, including a wide range of eyewear.

POSITION SUMMARY

The Coding Specialist will report to the Revenue Cycle Manager and will focus on ensuring correct code selection, including modifiers, and abiding by CMS and payer coding guidelines and compliance regulations. The coder will be responsible to review and assign medical codes and ensuring accuracy relating to billing requirements. The position requires knowledge of ICD-10-CM, CPT, and HCPCS coding systems, as well as ophthalmology-specific medical terminology. 1099 contractors also considered.

POSITION DUTIES AND RESPONSIBILITIES

• Responsible for reviewing and entering appropriate ICD-10-CM, CPT, and HCPCS codes based on medical documentation, including physician notes.
• Responsible for submitting accurate coding and billing procedures to obtain appropriate reimbursement for commercial, government, third party payers, and other network entities.
• Ensures correct code selection, including modifiers, and abiding by the coding guidelines and compliance regulations.
• Correct errors through TriZetto clearinghouse relating to diagnosis and HCPCS codes.
• Serves as a point of contact for billing problem solving.
• Responds to requests from management, staff, or physicians in a timely manner.
• Follows department policies and procedures to ensure accurate and timely claim resolution.
• In-depth knowledge of payer Billing Coverage Policies and clinical billing policies.
• Maintain high level of patient confidentiality to ensure compliance with HIPAA, OSHA and PHI regulations.
• Communicate with management to resolve billing disputes and escalations.
• Other duties as assigned.

DESIRED TECHNICAL AND PROFESSIONAL SKILLS AND EXPERIENCE

• Minimum 2 years of experience of coding in Ophthalmology.
• Experience in claim submissions, denials, appeals, injections, audits, and payer correspondence.
• Familiar with NextGen and Trizetto systems to submit and resolve insurance issues.
• Perform chart and patient account auditing review.
• Excellent communication skills.
• Strong problem-solving skills.
• Knowledge of commercial coding and government billing regulations.

· Minimum of 2 years of experience in NextGen billing system

· Excellent verbal and written communication skills and attention to details

· Ability to work independently with minimal supervision

· Advanced use of Microsoft Office applications (Word, Excel, PowerPoint, Outlook) and commercial payer resources portals.

PHYSICAL REQUIREMENTS

• Prolonged periods of sitting, standing, and computer use.
• Frequent use of standard office equipment, including computers, telephones, scanners, and copiers.
• Ability to occasionally lift and carry up to 20 pounds.
• Ability to move throughout the clinic as needed to support patient care and office operations.

ATTENDANCE REQUIREMENTS

• Regular, reliable, and punctual attendance is an essential function of this position.
• Ability to work scheduled hours and occasional overtime as needed to meet operational demands.
• This position is on site.

For full-time employees, Bloom Family Eye Surgeons offers vision care discounts, a Simplicity Health Direct Primary Care membership, dental insurance, a 401(k) plan, and paid time off.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Paid time off
• Retirement plan

Experience:

• Ophthalmology medical billing: 2 years (Preferred)

Ability to Commute:

• Dayton, OH 45432 (Required)

Ability to Relocate:

• Dayton, OH 45432: Relocate before starting work (Required)

Work Location: In person