Senior Medical Billing Representative role within the Revenue Cycle team at Ophthalmic Consultants of Boston (OCB). This position supports the financial health of the organization by resolving complex billing issues, improving reimbursement outcomes, and helping maintain a seamless experience for patients and providers. The role is full-time and onsite in Plymouth, MA.
Key responsibilities include:
- Resolving complex claim edits, rejections, and denials accurately and efficiently
- Leading advanced accounts receivable follow-up to support timely reimbursement
- Analyzing denial trends and implementing proactive solutions
- Writing detailed appeal letters aligned with clinical documentation and payer policies
- Ensuring compliance with timely filing requirements and regulatory standards
- Reviewing and validating patient demographics, insurance details, charges, and coding
- Serving as a subject matter expert for billing processes, coding, and payer requirements
- Collaborating with insurance carriers, patients, physicians, and internal teams to resolve inquiries
- Supporting eligibility verification, authorizations, and referral processes
- Reviewing medical records for medical necessity alignment
- Identifying workflow improvements to reduce denials and improve efficiency
- Assisting with onboarding, training, and mentoring new team members
Requirements & Qualifications
Qualifications and experience sought:
- Several years of experience in medical billing or revenue cycle operations
- Strong knowledge of medical terminology, ICD-10 diagnosis codes, and CPT-4 procedure codes
- Advanced understanding of coding modifiers and their appropriate use
- Proven expertise in accounts receivable follow-up and denial management
- Deep understanding of insurance eligibility, benefits, and reimbursement processes
- Familiarity with payer medical necessity requirements and billing policies
- Excellent communication and customer service skills
- Strong analytical, organizational, and problem-solving abilities
- High attention to detail and accuracy
- Ability to manage multiple priorities effectively
- Proficiency with Microsoft Office tools, including Word, Excel, and Outlook
- Solid understanding of HIPAA regulations
- College degree preferred
- CPC, COPC, or similar certification preferred
Benefits & Perks
OCB offers:
- Medical and dental insurance starting on the first day of employment
- 401(k) plan with company match
- Company-paid life insurance
- Company-paid long-term disability
- Eye care discounts
- Generous paid time off and paid holidays
Location
Massachusetts, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
2 weeks ago