Senior Billing Representative

Ophthalmic Consultants of Boston, Inc; Plymouth Mobile Estates (MA); On-site; USD 33,000 - 50,000; Full time

Job summary

Ophthalmic Consultants of Boston, Inc. is seeking a Senior Medical Billing Representative in Plymouth, MA to drive revenue cycle excellence and support patient care.

You will serve as a subject matter expert in medical billing, denial management, and AR follow-up while collaborating with providers, payors, patients, and internal teams. This full-time role runs Monday–Friday, 8:00 AM–4:30 PM at our Plymouth location.

Qualifications

• Strong knowledge of medical terminology and coding (ICD-10, CPT).
• Experience with denial management and appeals.
• Experience in revenue cycle management and AR operations.
• Attention to detail and strong analytical skills.
• Excellent communication and customer service.

Responsibilities

• Review, investigate, and resolve complex claim edits, rejections, and billing discrepancies.
• Perform advanced accounts receivable follow-up on unpaid, underpaid, and denied claims.
• Analyze denial trends and implement corrective actions to improve reimbursement outcomes.
• Prepare and submit detailed appeals with records and payor guidelines.
• Ensure timely filing requirements are met.
• Verify patient demographics and insurance information; monitor eligibility and referrals.
• Provide guidance to team on billing processes and payor requirements.

Skills

Medical terminology

ICD-10 coding

CPT coding

Denial management

Accounts receivable

Analytical skills

Communication skills

Time management

HIPAA compliance

Microsoft Office

Education

Associate's or Bachelor's degree

CPC certification

COPC certification

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Plymouth, MA, US

Salary Range: $24.00 To $36.00 Hourly

Senior Medical Billing Representative

Drive Revenue Cycle Excellence. Make a Direct Impact on Patient Care.

Are you a seasoned medical billing professional who thrives on solving complex challenges, improving processes, and mentoring others? We're looking for a Senior Medical Billing Representative to join our team and play a key role in maximizing reimbursement, ensuring compliance, and supporting operational excellence across the revenue cycle. In this highly visible role, you'll serve as a subject matter expert in medical billing, denial management, and accounts receivable follow-up while collaborating closely with providers, payors, patients, and internal teams. If you're passionate about revenue cycle performance, continuous improvement, and delivering exceptional results, we'd love to hear from you.

This is a fulltime opportunity: M-F, 8-4:30PM in our Plymouth location.

What You'll Do

As a Senior Medical Billing Representative, you will:

• Review, investigate, and resolve complex claim edits, rejections, and billing discrepancies.
• Perform advanced accounts receivable follow-up on unpaid, underpaid, and denied claims.
• Analyze denial trends and implement corrective actions to improve reimbursement outcomes.
• Prepare and submit detailed appeals supported by medical records, documentation, and payor guidelines.
• Ensure claims and appeals meet all timely filing requirements.

Optimize Revenue Cycle Performance

• Verify and maintain accurate patient demographics, insurance information, charges, and coding updates.
• Monitor insurance eligibility, benefits, authorization requirements, and referral needs.
• Review medical documentation to ensure compliance with payor medical necessity policies.
• Process authorization requests and track approvals for procedures and services.
• Manage patient and insurance refund requests and monitor self-pay balances.
• Coordinate collection activities and agency placements when appropriate.

Serve as a Billing Subject Matter Expert

• Provide guidance and support to team members regarding billing processes, coding, denials, and payor requirements.
• Act as a key resource for resolving escalated billing inquiries and complex account issues.
• Build productive relationships with insurance carriers, physician offices, patients, and internal departments.
• Assist with onboarding and training new team members.
• Identify trends impacting reimbursement and recommend process enhancements.
• Stay current on healthcare regulations, billing guidelines, and payor policy changes.
• Communicate industry and regulatory updates to the billing team to ensure compliance and best practices.

Required Qualifications

• Strong knowledge of medical terminology, ICD-10 diagnosis coding, and CPT procedure coding.
• Advanced understanding of coding modifiers and their appropriate application.
• Several years of experience in medical billing, revenue cycle management, or accounts receivable operations.
• Proven success in denial management, appeals, and insurance follow-up.
• Strong analytical and problem-solving skills with exceptional attention to detail.
• Excellent communication and customer service abilities.
• Ability to prioritize multiple responsibilities in a fast-paced environment.
• Working knowledge of insurance eligibility, benefit verification, reimbursement methodologies, and referral requirements.
• Understanding of HIPAA regulations and compliance standards.
• Proficiency with Microsoft Office applications, including Word, Excel, and Outlook.

Preferred Qualifications

• Associate's or Bachelor's degree.
• Professional certification such as:
  • Certified Professional Coder (CPC)
  • Certified Ophthalmology Professional Coder (COPC)
• Experience in ophthalmology or a specialty medical practice setting.

Why Join Our Team?

At our organization, you'll have the opportunity to:

• Make a meaningful impact on financial performance and patient experience.
• Work alongside experienced healthcare professionals in a collaborative environment.
• Share your expertise while helping develop and mentor team members.
• Contribute to process improvements that enhance efficiency and revenue cycle success.
• Grow your career with a team that values accuracy, accountability, and continuous learning.