• Submit and monitor insurance claims for accurate and timely reimbursement. • Post and reconcile insurance and patient payments. • Perform AR follow-up with insurance companies to resolve unpaid or underpaid claims. • Investigate claim status, payment discrepancies, and outstanding balances. • Assist with patient billing inquiries as needed. • Review denied and rejected claims in Athena EHR. • Research denial reasons and implement corrective actions. • Prepare and submit claim appeals with supporting documentation. • Correct billing, coding, or eligibility issues and resubmit claims. • Track denial trends and maintain documentation of resolutions. • Generate billing, collections, and revenue reports. • Track free care, write-offs, and uncompensated services. • Assist with revenue reconciliation and reporting. • Identify opportunities to improve collections and cash flow.

• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes. • Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers.

Role Description We are seeking a detail-oriented Medical Billing Specialist to join our experienced billing team. This role is responsible for accurately preparing and submitting claims, resolving billing issues, and ensuring timely reimbursement. The ideal candidate thrives in an independent, self-starter work environment and demonstrates strong accuracy, problem-solving, and accountability. Key Responsibilities - Prepare, review, and submit insurance claims accurately and timely - Verify patient insurance coverage and eligibility - Perform charge posting and ensure accurate diagnosis documentation - Follow up on unpaid or denied claims to facilitate resolution - Respond to inquiries from patients, optometrists, and internal staff - Review edits and make necessary corrections prior to claim submission - Maintain compliance with billing regulations, policies, and procedures Qualifications - Background in optometry or ophthalmology billing strongly preferred - Experience working with multiple EHR systems; familiarity with Epic is a plus - Ability to work independently with expectation to be fully autonomous within 6 months and transition to Epic within 12 months Requirements - Requires high school diploma or equivalent - Requires two years experience in medical insurance billing in a healthcare or insurance organization - Requires working knowledge of medical billing practices and clinical policies and procedures - Requires working knowledge of CPT and ICD medical coding - Requires demonstrated ability to operate a ten-key adding machine by touch - Requires ability to operate personal computer and familiarity with various software applications - Requires excellent written and verbal communication skills - Requires attention to detail with accuracy for extended periods of time under strict time constraints - Requires analytical skills to help identify problems and recommend solutions - Requires attending ongoing educational programs to ensure current and accurate industry knowledge - Requires highest level of professional behavior in manner, appearance and communication pursuant to department guidelines - Requires ability to maintain confidentiality of any patient or employee medical, financial or personal information; including records and data to which there is access - Responsible to challenge unauthorized individuals from viewing such confidential patient or employee information or accessing restricted areas Benefits - Access to diverse opportunities to learn and develop in meaningful ways - Advanced clinical training - Leadership development - Promotion opportunities - Cross training development

• Responsible for accurately processing patient billing, managing insurance claims, and ensuring timely reimbursement. • Duties include reviewing medical records, coding procedures, and collaborating with healthcare providers and insurance companies to resolve discrepancies. • Strong attention to detail, knowledge of medical terminology, and proficiency in billing software are essential for success in this role. • Verify insurance benefits and confirm patient eligibility. • Obtain prior authorization for services as required. • Review clinician entered charges entered for accuracy before generating claims. • Prepare and submit claim files. • Post insurance and clients payments accurately and in a timely manner. • Analyze and address ERA/EOB denials by taking appropriate corrective action. • Manage accounts receivable and actively pursue outstanding balances. • Oversee client collections to ensure timely payment. • Handle insurance appeals for denied or underpaid claims. • Stay informed and compliant with payor reimbursement policies, procedures, and guidelines. • Monitor and apply contracted fee schedules to ensure accurate expected payment. • Foster positive communication and relationships with patients, clinicians, physicians, third-party payors, and other Boundless staff to ensure exceptional customer service. • Adheres to company policies and procedures in addition to regulations, laws and other requirements from applicable governing bodies, certification, licensure and/or accreditation entities, etc. • Other duties as assigned.