Billing Office Supervisor – Retina Specialty Practice
Position Summary
The Billing Office Supervisor is responsible for overseeing the daily operations of the billing department for a busy multi-location Retina and Ophthalmology practice. This position manages all revenue cycle activities, including charge entry, claim submission, payment posting, denial management, accounts receivable follow-up, patient collections, and financial reporting. The supervisor will lead and develop billing staff while ensuring compliance with Medicare, commercial insurance carriers, and retina-specific coding and reimbursement guidelines.
The ideal candidate will have extensive experience in ophthalmology and retina billing, strong leadership skills, and a proven track record of improving revenue cycle performance and financial outcomes.
Essential Duties and Responsibilities
Revenue Cycle Management
- Supervise all aspects of the revenue cycle from charge capture through final payment.
- Monitor billing workflows to ensure timely claim submission and reimbursement.
- Review and analyze aging reports, denial reports, rejection reports, and payment trends.
- Develop and implement strategies to reduce Accounts Receivable (A/R) and improve cash collections.
- Ensure timely follow-up on unpaid claims and appeals.
- Oversee patient balance collection processes and payment arrangements.
- Monitor reimbursement trends and identify opportunities for revenue enhancement.
Retina and Ophthalmology Billing Oversight
- Maintain expertise in retina-specific coding, billing, and reimbursement regulations.
- Ensure proper coding and billing for:
- Intravitreal injections
- Retina laser procedures
- Vitrectomy procedures
- Retinal detachment repairs
- OCT imaging
- Fluorescein angiography
- Fundus photography
- Visual field testing
- Minor and major surgical procedures
- Drug administration and biologic medications
- Oversee billing and reimbursement for high-cost injectable medications including buy-and-bill inventory management.
- Ensure compliance with Medicare Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and payer-specific requirements.
- Familiarity with funding programs that help our patients to receive care they need.
Financial Management and Reporting
- Prepare and present monthly billing and financial performance reports.
- Analyze key performance indicators (KPIs), including:
- Days in A/R
- A/R over 90 days
- Net collection rate
- Gross collection rate
- Denial rate
- First-pass claim acceptance rate
- Charge lag
- Payment lag
- Patient collection percentages
- Identify trends affecting practice revenue and recommend corrective actions.
- Assist leadership with budgeting, forecasting, and financial planning related to revenue cycle operations.
- Reconcile billing data and ensure accuracy of financial reporting.
Leadership and Staff Management
- Supervise, train, mentor, and evaluate billing department personnel.
- Conduct regular staff meetings and performance reviews.
- Establish productivity and quality benchmarks for team members.
- Ensure cross-training within the department to promote operational continuity.
- Foster a culture of accountability, collaboration, and continuous improvement.
Compliance and Quality Assurance
- Ensure compliance with HIPAA, CMS regulations, and payer requirements.
- Conduct regular audits of billing and coding activities.
- Maintain current knowledge of changes in coding, reimbursement, and regulatory requirements.
- Collaborate with providers and clinical staff to improve documentation supporting accurate billing.
Collaboration and Communication
- Work closely with physicians, administrators, clinical managers, and front desk leadership.
- Provide education and support regarding billing policies and reimbursement issues.
- Serve as the primary resource for complex billing and payer-related concerns.
Qualifications
Required
- Minimum 3 years of medical billing experience.
- Minimum 1 years of supervisory or management experience.
- Extensive knowledge of ophthalmology and retina billing practices.
- Strong understanding of Medicare, Medicaid, and commercial payer regulations.
- Experience managing Accounts Receivable and denial management programs.
- Proficiency with practice management and electronic health record systems.
- Advanced knowledge of CPT, ICD-10, HCPCS, and modifier usage.
- Strong analytical and financial reporting skills.
- Excellent communication and leadership abilities.
Preferred
- Retina specialty billing experience.
- Experience with multi-location physician practices.
- Knowledge of inventory and reimbursement management for specialty pharmaceuticals and injectable medications.
Key Performance Expectations
- Maintain A/R greater than 90 days below industry benchmarks.
- Achieve first-pass claim acceptance rates above 95%.
- Maintain denial rates below 5%.
- Improve net collection rates and reduce claim turnaround times.
- Ensure timely and accurate billing for all services rendered.
- Provide monthly KPI reporting and actionable recommendations to leadership.
Physical Requirements
- Ability to sit for extended periods while working on a computer.
- Ability to communicate effectively with staff, providers, patients, and insurance representatives.
- Occasional travel between clinic locations may be required.
Reports To
Supervises
- Billing Specialists, Payment Posters, A/R Representatives, Collection Specialists, and other Revenue Cycle personnel.
Benefits:
- 401(k)
- Health insurance
- Health savings account
- Paid time off
- Retirement plan
Work Location: In person
