Ophthalmology Medical Billing Specialist

Paylocity; Somersworth (NH); On-site; USD 42,000 - 62,000; Full time

Job summary

Paylocity is seeking a Medical Biller to support the full revenue cycle, including claims submission, denials management, and patient billing inquiries. The role requires meticulous claim review, adherence to CPT/ICD-10 rules, and collaboration with internal teams to optimize reimbursement.

Responsibilities include posting payments, reconciling accounts, assisting with payment plans, and maintaining HIPAA-compliant records in a professional healthcare setting.

Qualifications

• High school diploma or GED required.
• Experience in medical billing, coding, AR, or payment posting preferred.
• Working knowledge of medical terminology, insurance guidelines, and claim-processing requirements.
• Strong analytical, problem-solving, organizational, and time-management skills.
• Excellent written and verbal communication skills.
• Ability to work independently while collaborating with patients, providers, payers, and internal teams.

Responsibilities

• Review and validate claims for accurate patient, insurance, diagnosis, procedure, modifier, and other required information.
• Prepare, correct, and submit clean claims to insurance companies per payer and organizational requirements.
• Apply knowledge of CPT, ICD-10, HCPCS, ophthalmology coding, and state/federal guidelines.
• Research and resolve claim rejections, denials, underpayments, and other AR issues.
• Prepare and submit appeals with supporting documentation for timely reimbursement.
• Post and reconcile patient and insurance payments (checks, EFTs, credit cards, EOBs).
• Process adjustments, credits, refunds, and corrections with accurate records.
• Respond to patient calls/messages about balances, processing, and payment options.
• Collect patient payments and assist with payment plans per policies.
• Update patient, guarantor, and insurance information as needed.
• Manage billing communications, faxes, referrals, payer requests, and supporting documentation.
• Assist with specialized billing functions (VA, workers’ comp, surgical billing, end-of-day reconciliation, fee schedules, reporting).
• Support prior authorization and insurance verification within training scope.
• Identify opportunities to improve billing accuracy, efficiency, compliance, and revenue cycle performance.
• Maintain organized documentation and comply with SOPs, HIPAA, payer guidelines, and policies.
• Provide cross-coverage and assist with other revenue cycle responsibilities as needed.

Skills

Medical billing

Accounts receivable

HIPAA knowledge

Verbal & written communication

Attention to detail

Problem solving

Education

High school diploma

Tools

ModMed EMR

Job description

Paylocity is seeking a Medical Biller to support the full revenue cycle, including claims submission, denials management, and patient billing inquiries. The role requires meticulous claim review, adherence to CPT/ICD-10 rules, and collaboration with internal teams to optimize reimbursement.

Responsibilities include posting payments, reconciling accounts, assisting with payment plans, and maintaining HIPAA-compliant records in a professional healthcare setting.