General Summary
Provide lead support to the team and coordinate the workflow to ensure performance is maintained. Coach, train, support, and offer guidance to Charge Posters in the accurate posting of charges, payments, and adjustments for Ophthalmology Ambulatory Surgery Center (ASC) and Practice. Ensure timely and precise charge entry, claim submissions, and revenue cycle support to optimize reimbursement and maintain compliance with payer guidelines.
Essential Functions
Oversee the work of the division/team staff and manage the daily work volume including service agreements with business partners
Monitor team performance; provide prompt, objective coaching and counseling; apprise supervisor of successes and concerns; provide input for performance evaluations
Coordinate with other units/departments to facilitate special requests, change in processes and resolution of workflow/production issues
Ensure all department processes and performance standards are documented accurately; develop and maintain department procedure manuals; train division/team employees on current or revised unit processes and procedures
Enter and post charges for ophthalmology practice and ASC services (e.g., cataract surgery, retina injections, laser procedures).
Verify coding accuracy, ensuring proper use of CPT, HCPCS, and ICD-10 codes based on provider documentation
Review encounter forms, operative notes, and clinical documentation to confirm correct charge capture
Ensure timely submission of claims to insurance companies, minimizing denials and rejections
Audit charge entry for accuracy and compliance with payer policies and reimbursement guidelines
Post payments from patients, ensuring correct application to accounts
Identify and correct posting errors, underpayments, and overpayments
Ensure compliance with Medicare, Medicaid, commercial payer policies, and ASC billing regulations
Stay updated on coding changes, payer requirements, and regulatory updates
Perform daily claim reconciliation, ensuring all charges have been captured and submitted correctly
Reconcile batches at the end of the day, ensuring that all financial records are balanced
Identify and resolve claim discrepancies, coding errors, and missing documentation working with physicians, clinical staff and revenue cycle teams to correct
Review insurance denials and work with the appeals team to submit corrections
Coordinate with the Surgery Center team to verify and ensure proper billing for all procedures performed
Generate daily, weekly, and monthly reports on charge posting
Communicate billing and payment trends to management, identifying areas for process improvement
Job Specifications
Typically has the following skills or abilities:
Minimum of 3 years of experience in medical billing, charge posting, or revenue cycle management in a healthcare setting
One year experience with ophthalmology billing and ASC revenue cycle processes preferred
Certified Professional Coder (CPC) or Certified Ophthalmology Coder (COC) certification preferred
Proficiency in EHR, billing software, and Microsoft Office (Excel, Word, Outlook)
Bilingual (English & Spanish) preferred
Strong understanding of medical billing, coding, and charge entry for ophthalmology and ASC procedures
Experience with CPT, HCPCS, ICD-10, and payer-specific coding guidelines
Proficiency in electronic health records (EHR) and practice management systems (NextGen preferred)
Familiarity with Medicare, Medicaid, and commercial payer billing regulations
Ability to identify and resolve charge posting discrepancies and claim errors
Excellent analytical, problem-solving, and reconciliation skills
Strong attention to detail and accuracy in data entry
Ability to work independently and as part of a team in a fast-paced environment
Working Conditions
The working environment is generally favorable. Lighting and temperature are adequate, and there are no hazardous or unpleasant conditions caused by noise, dust, etc.
The above information in this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.
