Virtual Certified Ophthalmic Coder & Billing Coordinator (Retina)

We are seeking a highly experienced, certified, and detail-oriented Virtual Certified Ophthalmic Coder & Billing Coordinator (Retina) to support a premier ophthalmology practice. In this critical clinical revenue cycle role, your primary focus will be live-coding complex ophthalmic and retinal patient visits, managing J-code injectable drug claims, posting payments, and acting as the main operational liaison between the clinic and our third-party billing company.

Because this role demands high-level clinical coding accuracy, a minimum of 5+ years of direct ophthalmology coding experience, specialized background in retina coding, active coding certification, and live-coding mastery are absolute, non-negotiable requirements. General medical billers without direct hands-on ophthalmology coding expertise will not be considered.

Working Environment & Core Schedule

• Role Title: Virtual Certified Ophthalmic Coder / Billing Coordinator (Retina)
• Specialty: Ophthalmology & Retina
• Status: Full-Time (40 Hours / Week)
• Schedule: Monday – Friday, 8:00 AM – 5:00 PM PST (Pacific Standard Time)
• Core Technology Stack: Ophthalmology EHR platforms (e.g., ModMed / DrChrono), Clearinghouses, Payer Portals, Practice VoIP System
• Primary Objective: Real-time visit live-coding, J-code processing, payment posting, and third-party billing agency liaison oversight

Top 3 Daily Tasks

Live Clinical Visit & J-Code Coding: Review clinical documentation in real time to code complex retina visits, surgical procedures, and intravitreal injectable drug J-codes using precise ICD-10 and CPT coding guidelines.

Payment Posting & Discrepancy Auditing: Post payments accurately from ERAs/EOBs, reconcile accounts, and audit payment postings to uncover fee schedule discrepancies or coding-related claim rejections.

Third-Party Billing Company Liaison Support: Work directly with the practice manager and outsourced billing agency to track unbilled encounters, resolve coding denials, push claim corrections, and report on pending revenue items.

Core Responsibilities

• Ophthalmic & Retina Live-Coding (Primary Focus): Execute real-time CPT and ICD-10 coding for clinical encounters, retinal procedures, intravitreal injections, and specialized diagnostic testing.
• J-Code & Injectable Drug Management: Ensure precise coding and compliance for high-cost ophthalmic drugs and biologic injectables (J-codes), verifying unit quantities and modifier application.
• Documentation & Discrepancy Auditing: Audit provider chart documentation against submitted codes to capture unbilled services, catch clinical discrepancies, and ensure billing integrity prior to claim submission.
• Payment Posting & AR Audit: Post electronic and manual payments, identify line-item discrepancies, and address coding-related denials or payor bundling rejections.
• Outsourced Billing Agency Coordination: Serve as the practice’s primary contact for the third-party billing company—tracking claim transmission cadences, resolving coding edits, and holding external billers accountable.
• Administrative & Practice Manager Support: Own all coding workflows, deliver transparent weekly status reports on pending charts, and directly relieve administrative bottlenecks for clinic leadership.

Requirements:

• 5+ Years Ophthalmology Coding Experience: Extensive, proven background coding for an ophthalmology practice, with direct specialization in retina coding.
• Active Medical Coding Certification: Hold an active credential such as CPC (Certified Professional Coder), COC, CCS, or COA/OCP (Ophthalmic Coding Specialist).
• Live-Coding & J-Code Mastery: Demonstrated expertise in real-time live coding of provider notes and deep familiarity with J-codes / injectable drug coding.
• CPT & ICD-10 Expertise: Advanced knowledge of ophthalmic CPT codes, modifiers, ICD-10 diagnostic codes, and payor LCD/NCD coverage policies.
• Payment Posting & Billing Operations: Hands-on experience posting payments, analyzing EOBs/ERAs, and auditing claim denial patterns.
• Schedule Availability: Full availability to work 40 hours per week during Monday through Friday, 8:00 AM – 5:00 PM PST.
• Remote Workspace Setup: Dedicated, private home office with a lockable door, high-speed primary internet connection, backup power/internet solutions, a high-performance computer (PC/Mac), and a noise-canceling headset in full compliance with HIPAA rules.

Preferred Qualifications

• Direct coding experience for intravitreal injections, retinal detachments, laser surgeries, and complex retinal imaging.
• Hands-on proficiency with ModMed (Modernizing Medicine / EMA) or DrChrono EHR systems.
• Prior experience coordinating workflows alongside an outsourced third-party billing agency.
• Experience directly supporting an ophthalmology practice manager or clinic director.

Ideal Candidate Profile

You are a master-level certified ophthalmic coder who thinks like a clinician and audits like a financial officer. You navigate retina CPT codes and J-codes with complete confidence, catch documentation errors in real time, keep payment posting tight, and seamlessly manage outsourced billing teams to ensure maximum practice reimbursement during PST business hours.