Certified Ophthalmic Coder, Billing Coordinator – Retina
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Job Description
Certified ophthalmic coder managing live retina visit coding, J-code claims, payment posting, and audits. Coordinating outsourced billing operations for an ophthalmology practice during PST hours.
Responsibilities:
- Review clinical documentation in real time to code complex retina visits, surgical procedures, and intravitreal injectable drug J-codes using precise ICD-10 and CPT coding guidelines.
- Post payments accurately from ERAs/EOBs, reconcile accounts, and audit payment postings to uncover fee schedule discrepancies or coding-related claim rejections.
- Work directly with the practice manager and outsourced billing agency to track unbilled encounters, resolve coding denials, push claim corrections, and report on pending revenue items.
- Execute real-time CPT and ICD-10 coding for clinical encounters, retinal procedures, intravitreal injections, and specialized diagnostic testing.
- Ensure precise coding and compliance for high-cost ophthalmic drugs and biologic injectables (J-codes), verifying unit quantities and modifier application.
- Audit provider chart documentation against submitted codes to capture unbilled services, catch clinical discrepancies, and ensure billing integrity prior to claim submission.
- Post electronic and manual payments, identify line-item discrepancies, and address coding-related denials or payor bundling rejections.
- Serve as the practice’s primary contact for the third-party billing company—tracking claim transmission cadences, resolving coding edits, and holding external billers accountable.
- Own all coding workflows, deliver transparent weekly status reports on pending charts, and directly relieve administrative bottlenecks for clinic leadership.
Requirements:
- 5+ Years Ophthalmology Coding Experience: Extensive, proven background coding for an ophthalmology practice, with direct specialization in retina coding.
- Active Medical Coding Certification: Hold an active credential such as CPC (Certified Professional Coder), COC, CCS, or COA/OCP (Ophthalmic Coding Specialist).
- Live-Coding & J-Code Mastery: Demonstrated expertise in real-time live coding of provider notes and deep familiarity with J-codes / injectable drug coding.
- CPT & ICD-10 Expertise: Advanced knowledge of ophthalmic CPT codes, modifiers, ICD-10 diagnostic codes, and payor LCD/NCD coverage policies.
- Payment Posting & Billing Operations: Hands-on experience posting payments, analyzing EOBs/ERAs, and auditing claim denial patterns.
- Schedule Availability: Full availability to work 40 hours per week during Monday through Friday, 8:00 AM – 5:00 PM PST.
- Remote Workspace Setup: Dedicated, private home office with a lockable door, high-speed primary internet connection, backup power/internet solutions, a high-performance computer (PC/Mac), and a noise-canceling headset in full compliance with HIPAA rules.
- Preferred: Direct coding experience for intravitreal injections, retinal detachments, laser surgeries, and complex retinal imaging.
- Preferred: Hands-on proficiency with ModMed (Modernizing Medicine / EMA) or DrChrono EHR systems.
- Preferred: Prior experience coordinating workflows alongside an outsourced third-party billing agency.
- Preferred: Experience directly supporting an ophthalmology practice manager or clinic director.
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