Ophthalmology Medical Billing Specialist (Remote, Nightshift)

Outsourcey; Philippines; Remote; PHP 391,000 - 614,000; Full time

Benefits offered by this job

Competitive salary

Career growth opportunities

Remote work option

Job summary

Outsourcey seeks a skilled Medical Billing Specialist in the Philippines to support end-to-end billing for ophthalmology services. You will review charts, submit clean claims, follow up with payers, and resolve denials with accuracy and HIPAA-compliant practices.

The role emphasizes meticulous chart reviews, data integrity, and proactive aging-A/R management while collaborating with providers and insurance companies to ensure timely reimbursement.

Qualifications

• 2.5+ years of medical billing experience in related fields
• Strong ophthalmology/eye-care billing exposure preferred
• Experience with payment posting and reconciliation required
• Experience with A/R and aging reports required
• Proficiency in claims scrubbing, submission, and insurer follow-up
• Ability to review medical charts prior to billing
• Knowledge of ICD-10-CM, CPT, HCPCS and modifiers
• Understanding of documentation requirements and medical necessity
• Experience billing Medicare and commercial plans
• Experience resolving denials and appeals

Responsibilities

• Review patient charts and docs before claim submission
• Conduct detailed chart reviews to support billing
• Verify diagnoses, procedures, modifiers, and billing data
• Submit clean claims electronically to payers
• Monitor claim status and resubmit as needed
• Post insurance and patient payments accurately
• Review ERA/EOB and payer correspondence
• Research and resolve denials and underpayments
• Prepare corrected claims, reconsiderations, and appeals
• Track claims from submission to adjudication
• Maintain aging reports and follow up on outstanding balances
• Ensure HIPAA compliance in all billing activities
• Communicate effectively with insurers, providers, and staff

Skills

Medical billing

Revenue cycle management

Accounts receivable

Claims processing

ICD-10-CM

CPT/HCPCS

HIPAA compliance

EHR/EMR proficiency

Clearinghouse understanding

Denials management

Insurance follow-up

Payment posting

A/R aging reports

Eye-care billing

Communication with payers

Tools

EMR software

Practice management systems

Clearinghouse portals

Job description

Looking to take your career to the next level? Then this role is for you!

Join Outsourcey and be part of our mission to revolutionize global talent expansion! We connect businesses with dedicated full-time teams in the Philippines, offering cost-efficient solutions without compromising quality. Join us and help elevate businesses with complete control and comprehensive support, let's shape the future of work together!

Profile Requirements:

• Min 2.5 Years of Proven Experience in Medical Billing, Revenue Cycle Management, Accounts Receivable, Claims Processing, or a similar role
• Previous ophthalmology, optometry, eye surgery, or eye-care billing experience is strongly preferred
• Experience with payment posting and reconciliation is required
• Experience working A/R and aging reports is required
• Strong experience with claims scrubbing, claim submission, and insurance follow-up
• Experience reviewing medical charts and documentation prior to billing
• Strong knowledge of ICD-10-CM, CPT, HCPCS, and medical billing modifiers
• Understanding of documentation requirements and medical necessity
• Familiarity with ophthalmology procedures, diagnostic testing, surgical services, and medical eye-care terminology is strongly preferred
• Experience billing Medicare and commercial insurance plans
• Strong experience researching and resolving claim denials and rejections
• Experience preparing corrected claims, reconsiderations, and appeals
• Ability to read and interpret EOBs and ERAs
• Experience identifying underpayments, incorrect adjustments, and payment discrepancies
• Understanding of deductibles, copays, coinsurance, contractual adjustments, and patient responsibility
• Familiarity with insurance eligibility, prior authorizations, referrals, and payer requirements
• Ability to differentiate insurance-covered medical services from elective or self-pay services
• Experience using medical billing, EHR/EMR, clearinghouse, and practice-management systems
• Strong understanding of HIPAA and patient confidentiality
• Excellent attention to detail and numerical accuracy
• Strong analytical and problem-solving skills
• Ability to manage a large volume of claims and outstanding accounts
• Strong organizational and follow-up skills
• Ability to independently prioritize aging claims and take them through resolution
• Professional communication skills when interacting with insurance companies, patients, providers, and staff
• Self-motivated, dependable, persistent, organized, and capable of working independently

Core responsibilities:

• Review patient charts and documentation prior to claim submission
• Perform detailed chart reviews to ensure documentation supports services being billed
• Review provider documentation for completeness and identify missing information
• Verify diagnoses, procedures, modifiers, and other billing information before claims are submitted
• Identify documentation or coding issues that could result in claim denials or payment delays
• Communicate documentation deficiencies to the appropriate team member for correction
• Review charges for office visits, diagnostic testing, procedures, and surgical services
• Understand billing workflows associated with ophthalmology and medical eye care
• Assist with billing for services involving cataracts, glaucoma, corneal conditions, retinal conditions, diabetic eye care, and other medically necessary eye-care services
• Scrub claims before submission to identify errors, missing information, incorrect demographics, coding conflicts, modifier issues, and payer-specific problems
• Review claims for appropriate ICD-10-CM and CPT/HCPCS information
• Review modifier usage and identify claims requiring additional review
• Verify patient demographics and insurance information before submission
• Submit clean claims electronically to commercial insurance, Medicare, and other applicable payers
• Monitor claim acceptance and clearinghouse reports
• Correct and resubmit rejected claims promptly
• Track claims from initial submission through final adjudication
• Post insurance payments, patient payments, adjustments, contractual write-offs, and other transactions accurately
• Review electronic remittance advice (ERA), explanation of benefits (EOB), and payer correspondence
• Reconcile payments against submitted charges and expected reimbursement
• Identify underpayments, overpayments, incorrect adjustments, and unexpected payer reductions
• Research payment discrepancies and take appropriate follow-up action
• Maintain accurate patient account balances
• Work accounts receivable and aging reports consistently
• Review outstanding balances by aging category, including 30-, 60-, 90-, and 120+ day accounts
• Prioritize high-value and older outstanding claims
• Contact insurance companies regarding unpaid, delayed, denied, or underpaid claims
• Review payer portals and claim-status systems
• Document all insurance follow-up activity accurately
• Identify claims approaching timely-filing or appeal deadlines and take immediate action
• Maintain consistent follow-up until claims are appropriately resolved
• Research and resolve denied claims
• Identify denial reasons and determine appropriate corrective action
• Correct coding, demographic, authorization, eligibility, documentation, or submission issues when appropriate
• Prepare corrected claims, reconsiderations, and appeals
• Gather medical records and supporting documentation required for payer review
• Track denials and appeals through resolution
• Identify recurring denial trends and communicate opportunities to improve front-end billing processes
• Review insurance eligibility and benefits when needed
• Verify coverage for medical eye-care services and procedures
• Assist with reviewing deductibles, copays, coinsurance, and patient responsibility
• Identify authorization or referral requirements when applicable
• Help ensure required authorizations and supporting documentation are available before billing
• Distinguish appropriately between insurance-billable medical services and elective/self-pay services
• Maintain accurate records for patient responsibility and insurance balances
• Review patient accounts for incorrect balances or unapplied payments
• Assist with patient billing questions and account research when neededGenerate and review billing, payment, denial, and A/R reports
• Monitor key revenue-cycle metrics including outstanding A/R, aging, denials, clean-claim rate, and payment turnaround
• Maintain accurate notes within the practice-management and billing system
• Ensure billing activities comply with HIPAA, payer requirements, Medicare guidelines, and applicable billing regulations
• Maintain confidentiality of patient and financial information
• Stay current with payer policies and ophthalmology billing requirements
• Communicate effectively with providers, clinical staff, front-office staff, insurance companies, and patients
• Proactively identify billing issues that could delay reimbursement
• Take ownership of outstanding claims and follow them through resolution
• Assist with additional medical billing, payment posting, A/R, claims, denials, chart review, insurance follow-up, and revenue-cycle responsibilities as needed

Benefits:

Competitive salary Opportunity to shape the HR function of a rapidly growing BPO.

Work closely with a team of industry leaders who have successfully scaled BPOs in the past. Career growth and development opportunities.