Retina Billing Specialist

Billing Specialist – RetinaLocation: Fully RemotePay Range: $24–$30 per hourSchedule: Monday–Friday, 8:00 AM–5:00 PM in the assigned practice's time zoneEmployment Type: Direct HireBenefits: Medical, Dental, Vision, 401KAbout Our ClientAddison Group is hiring for our client, a rapidly growing specialty healthcare organization, seeking experienced Billing Specialists to support its expanding revenue cycle operations. Due to continued growth and new practice acquisitions, the organization is adding multiple professionals with a strong background in retina and ophthalmology billing.Although titled Billing Specialist, this position is heavily focused on insurance AR follow-up, denial resolution, and professional claims. Candidates must have hands-on retina billing experience and a solid understanding of injectable drug billing.Job DescriptionThe Billing Specialist will manage physician insurance claims throughout the revenue cycle, with a primary focus on resolving unpaid and denied accounts.

This position requires specialized knowledge of retina billing, J-codes, drug units, modifiers, and reimbursement.The role is entirely insurance-focused and does not involve patient collections or discussions regarding patient payment plans.Key ResponsibilitiesPerform insurance AR follow-up on outstanding and denied physician claimsResearch claim denials and determine the appropriate steps for resolutionPrepare and submit corrected claims, reconsiderations, and formal appealsReview professional claims for accuracy and completeness before submissionWork with retina-specific J-codes, injectable medications, drug units, and modifiersResearch reimbursement issues involving both commercial and government payersManage a significant volume of Medicare and Medicare-related claimsAssist with payment posting and charge entry when neededPartner with billing team members to identify claim errors and prevent recurring issuesUtilize payer portals and billing systems to research claim status and reimbursementMaintain detailed documentation of account activity and follow-up effortsSupport assigned specialty practices located throughout the countryQualifications1+ year of recent retina billing experience requiredHands-on experience with physician/professional fee billingStrong working knowledge of J-codes and injectable drug billingExperience applying and researching appropriate billing modifiersKnowledge of insurance AR follow-up and denial managementExperience working with commercial and government insurance plansAbility to read and interpret EOBs and payer responsesStrong analytical and problem-solving skillsComfortable managing a high-volume workload in a remote environmentSpecialized Retina ExperienceQualified candidates should have familiarity with several of the following:Billing for intravitreal injections and specialty ophthalmic medicationsRetina-specific J-codes and appropriate drug unitsDrug reimbursement and buy-and-bill processesBenefits verification for injectable medicationsPrior authorization requirements for retina treatmentsCommon ophthalmology modifiers, including laterality and procedure-related modifiersResolving denials involving injectable medications and physician servicesWork Environment100% remote positionFull-time Monday–Friday scheduleCandidates may support a practice operating in a different time zone and should be comfortable working the assigned practice's business hoursCollaborative and expanding Revenue Cycle teamStructured onboarding and systems training providedAddison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities.

Reasonable accommodation is available for qualified individuals with disabilities, upon request.