Medical Billing Manager - Ophthalmology - Santa Monica Eye Medical Group

ABOUT US

Since 1948, patients from throughout the greater Los Angeles area have found cutting-edge eye care at the Santa Monica Eye Medical Group, located in Santa Monica, California. The practice's founders, John E. Gilmore, MD, and Donald E. Dickerson, MD, developed the very first course in cataract intraocular lens surgery. Currently led by Dr. Sadiqa Stelzner, associate professor at UCLA, the doctors at the practice offer not only state-of-the-art eye care ranging from advanced surgical procedures including laser refractive surgery (LASIK), refractive laser-assisted cataract surgery (ReLACS), and micro-invasive glaucoma surgery (MIGS) and exams for glasses and contact lenses. We also specialize in a variety of aesthetic treatments to address scars, wrinkles, stretch marks, melasma, etc. As another convenience to our patients, we have on-site a state-of-the-art outpatient surgery center (ASC).

Today, Dr. Stelzner and her colleagues offer state-of-the-art treatments and compassionate patient care. They understand that the gift of sight changes lives, so they take the time to get to know their patients, listening to their concerns and experiences while also providing excellent care and medical treatment.

As a part of our team, you will be welcome to work with us for years to come as we do outstanding work serving our patients. We value team building, and our staff works to build relationships and play an essential role in our community.

JOB BRIEF

The Medical Billing Manager is a full-time position responsible for overseeing the billing and coding staff and making day-to-day decisions, understanding and coding all procedures within regulatory mandates, assisting with following up on insurance claims, and submitting appeals as needed. This position is responsible for directing and coordinating the overall functions of the billing and coding office to ensure the maximization of cash flow while improving patient, physician, and other customer relations. The Medical Billing Manager is responsible for billing all third-party payers, claims processing, payment posting, aged claim resolution, and charge posting.

This position generally works normal business hours Monday-Friday 8:00-5:00, with flexible schedules available.

A pleasant, warm and professional demeanor is essential. As a member of our team, we all provide a high level of efficient patient care, while always presenting a caring, ethical, friendly, and professional experience for the patients.

ESSENTIAL RESPONSIBILITIES

• Oversees the operations of the billing department, encompassing medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.
• Plans and directs patient insurance documentation, workload coding, billing and collections, and data processing to ensure accurate billing and efficient account collection.
• Serves as the practice expert and go-to person for all coding and billing processes.
• Analyzes billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues.
• Follows up on claims using various systems, such as Nextech EHR, TriZetto clearinghouse, etc.
• Maintains contacts with other departments to obtain and analyze patient information to document and process billings.
• Prepares and analyzes accounts receivable reports and weekly and monthly financial reports in concert with the CFO and Practice Manager. Collects and compiles accurate statistical reports.
• Keeps up to date with carrier rule changes and distributes the information within the practice.
• Analyzes trends impacting charges, coding, collection, and accounts receivable and take appropriate action to realign staff and revise policies and procedures with the approval of the Director of Operations.
• Successfully scrubs and QC's claims prior to submission.
• Manages the A/R, works rejected claims, and provides necessary follow-up to ensure successful claim processing.
• Posts insurance and patient payments, ensuring all posting is live in the system.
• Maintains strong attention to detail and ability to multi-task.
• Maintains extremely high standards of professional conduct.
• Establishes and maintains effective working relationships with the office staff and Doctors.
• Adheres to policies regarding safety, confidentiality, and HIPAA guidelines.
• Ensures that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.

EDUCATION AND EXPERIENCE

• Minimum 3+ years experience in Ophthalmology and Optometry.
• Experience with ASC surgery billing.
• Knowledge of medical terminology in Ophthalmology and Optometry.
• High school diploma required; Associate college degree preferred.
• Knowledge of CPT, HCPCS and ICD codes relating to Ophthalmology, Optometry and ASC surgeries.
• Knowledge and understanding of the workings optical medical offices.
• Proficient in Microsoft Word, Excel, fax, printers, scanners, and other office software.
• Experience working in retail optical software systems.
• Knowledge of billing for VSP and EyeMed.

QUALIFICATIONS / REQUIREMENTS

• Ability to work independently with minimal supervision.
• Must have strong organizational and time management skills.
• Ability to work on multiple tasks and meet deadlines.
• Detail-oriented.
• Be a team player.
• Resourceful and result driven.
• Must be able to communicate effectively with patients and office staff.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit, stand, walk, speak, hear, use hands, handle documents, bend and stoop as needed, and reach with hands and arms. The position requires use of keyboard and computer regularly. Strong vision abilities to perform computer-related work.