Job Description

We are seeking an exceptionally analytical, detailed-oriented, and results-driven Virtual Medical Biller / Accounts Receivable (A/R) Specialist to manage the revenue cycle operations for our premium ophthalmology practice. Operating in a highly specialized clinical field, our brand represents financial integrity, meticulous compliance, and elite operational performance.

This is not a passive data-entry role. We are looking to internalize and elevate our financial operations by adding a dedicated billing professional to improve claim resolution, drastically reduce outstanding accounts receivable, and optimize our revenue cycle alongside an existing outsourced team. The ideal candidate will possess deep, hands-on experience in specialized eye care billing, an authoritative mastery of full Revenue Cycle Management (RCM), and a proactive approach to resolving complex insurance denials.

Core Responsibilities

Accounts Receivable (A/R) & Full Revenue Cycle Management

• End-to-End RCM Oversight: Manage the complete medical billing lifecycle from clean claim submission through to final payment allocation, ensuring zero gaps in the financial pipeline.
• Aggressive A/R Recovery: Review aging reports, prioritize outstanding balances, and actively follow up with insurance carriers regarding unpaid, underpaid, or delayed claims to consistently optimize cash flow.
• Audit & Documentation: Maintain meticulous documentation of all collection efforts, payer communications, and billing files within the clinical ecosystem.

Denials, Appeals & Compliance

• Denial Investigation: Deeply investigate denied or rejected claims to pinpoint root causes, correct claim errors, and execute rapid resubmissions.
• Appeals Management: Prepare, document, and submit clinical and administrative appeals with solid supporting documentation, monitoring status through to final resolution.
• Specialty Coding & Medical Necessity: Review CPT, ICD-10, and modifier usage for total billing accuracy. Ensure all submitted claims strictly meet payer-specific guidelines and satisfy medical necessity criteria.

Requirements

• Ophthalmology Domain Expertise: Minimum of 2–3 years of specialized medical billing experience specifically within Ophthalmology or Retina practices. Ophthalmology surgery billing experience is a major asset.
• Payer Fluency: Solid, practical working knowledge of Medicare and Medi-Cal billing guidelines, reimbursement structures, and compliance standards.
• Software Literacy: Hands-on proficiency navigating DrChrono EMR is strongly preferred. Strong technical competency with digital clearinghouses and billing analytics tools is required.
• Phonetic & Verbal Excellence: Flawless verbal and written English communication skills. Must be highly articulate and professional when negotiating with insurance adjusters and collaborating with internal staff.
• Remote Workspace: Full-time availability (40 hours per week). Ability to work completely independently from a silent, distraction-free virtual home office.

Ideal Candidate Profile

The ideal candidate takes complete ownership of revenue recovery and billing performance. You are proactive, highly analytical, and possess a solution-oriented mindset that allows you to identify recurring denial trends and implement workflow improvements. You are built for a fast-paced specialty environment and pride yourself on keeping an A/R aging ledger exceptionally clean.