On-site ophthalmology coding auditor position in a private practice setting. The auditor reviews ophthalmology and optometry medical records for coding accuracy, regulatory compliance, and reimbursement optimization. This role works closely with the billing manager and clinic team to review clinical documentation, surgical charts, and diagnostic reports, identify billing risks, and provide direct feedback and education to providers and staff.
Key duties include:
- Conduct retrospective and prospective chart audits for complex ophthalmology services and diagnostic testing.
- Verify compliance with CMS, OIG, LCD, and payer guidelines.
- Validate correct use of ICD-10-CM, CPT, HCPCS, and eye-specific E/M codes, including modifiers.
- Provide provider and staff education to improve documentation and coding accuracy.
- Identify unbundling, under-coding, and other billing vulnerabilities.
- Review medical records for insurance requests and audits as directed.
- Collaborate with billing, denials, and practice management teams to resolve claim issues.
- Perform other duties as assigned by the Billing Manager.
Minimum 3–5 years of healthcare coding experience, including at least 2 years in ophthalmology or optometry coding and auditing.
Required or preferred qualifications:
- Active AAPC or AHIMA credential such as CPC, CPMA, or CCS.
- Specialized ophthalmology coding credential preferred.
- Strong knowledge of CPT, ICD-10, HCPCS, CCI edits, medical necessity, global surgical packages, and professional fee billing.
- Proficiency with computers, Word, and electronic health records.
- Strong communication skills and the ability to provide feedback directly to physicians.
- Ability to work independently.
- High school diploma or equivalent required; associate's or bachelor's degree in Health Information Management preferred.
- Ophthalmic technician experience is a plus.
Benefits include:
- PTO
- Health insurance
- 401(k)
- Health savings account
Schedule:
- Full-time
- Monday through Friday, 8:00 AM to 5:00 PM
- 1-hour lunch
- No weekends
Location
Connecticut, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
2 weeks ago