How to hire an optometry billing specialist: what to look for, where to find candidates and what to offer

In one line, the seat turns the care your practice delivers into paid claims: preparing and submitting claims to routine vision plans and to medical payers including Medicare, posting the payments that come back, and working everything that does not come back clean.

What an optometry billing specialist does covers the role from the worker's side. Your hiring question is narrower: which of those duties this seat owns in your practice, and what volume sits behind each one.

The payer mix is why the seat spans two billing worlds. In the 2022 AOA Survey of Optometric Practice (2021 data, from self-selected respondents), owner ODs reported gross billings coming 31% from direct patient payment and 30% from vision plans. Private medical insurance accounted for 23% and government programs for 16%, with 3% other, as reported.

The same survey reported an 84% collection rate on billings among responding owner ODs. Day to day, the seat earns its keep in the follow-up queue: rejected claims, plans that pend a claim and patient balances all sit there, and someone has to work them.

Write the posting against those workstreams: claim preparation and submission on both payer sides, payment posting, denial and rejection follow-up, and accounts-receivable aging with patient-balance follow-up. A posting that names only "insurance verification" is more likely to pull front desk resumes than biller resumes.

Ask which payer types a candidate has actually billed, not how many years they have billed. A candidate who has worked only vision plans has run one workflow; medical billing is a different one — diagnosis-driven claims to health insurers and Medicare, where documentation and denial letters carry the claim.

For an optometry practice the medical side is not an add-on. In the AOA survey mix above, 23% of owner ODs' billings came from private medical insurance and 16% from government programs, against 30% from vision plans — real volume on the medical side of the desk, not a token claim or two.

When you screen, medical-side experience shows up as specifics: which clearinghouse and payer portals the candidate has used, how they traced a denial back to a documentation fix, and whether they have billed Medicare before. Much of general medical-office billing carries over; the eye-care specifics — exam templates, payer portals, the practice's EHR — get learned on your systems.

You may see two credentials in optometry billing screens. The CPOC (Certified Paraoptometric Coder) is the AOA credential for proficiency in optometric coding, one of four paraoptometric certifications the AOA's Commission on Paraoptometric Certification offers. Its eligibility rule requires a high school diploma or equivalent plus at least two years of employment in the medical coding and billing field. AAPC's Certified Professional Coder (CPC) is a general outpatient and physician medical coding credential covering ICD-10-CM, CPT and HCPCS Level II.

Treat both as preferences that sort a resume stack, not requirements: they are voluntary certifications rather than state licenses, and the requirements that do bind the seat come from your payer contracts and the programs you bill. A strong biller without letters after their name beats a certified one who cannot explain how they worked a denial.

Work four channels. Post on an eye care job board so the seat reaches people already in eye care — see the optometry billing specialist listings candidates see — and check our guide to where to post the job for the channel-by-channel detail. Look inside the practice next: a front desk staffer who has been quietly untangling claims is already screened for temperament and knows your EHR.

Then look sideways and through your network. Billing staff out of dental, physician or durable-medical-equipment offices arrive with medical-billing repetitions and learn the eye-care specifics on your systems. Your EHR vendor's onboarding team, your accountant and neighboring practice owners are all worth asking when you are looking.

The in-eye-care bench is small: BLS OEWS May 2025 counted 4,460 billing and posting clerks employed in offices of optometrists nationally, against 404,060 across all industries. The larger pool sits outside eye care, with your payer specifics to learn.

On pay, start from federal data. Our research found no BLS occupation code for an optometry billing specialist — the seat title is our label — so the closest group is billing and posting clerks (SOC 43-3021). In BLS OEWS May 2025, that group employed in offices of optometrists shows a median of $45,130 a year ($21.7 an hour) with the middle half earning between $37,690 and $49,420. Across all industries nationally the median is $48,500, with a 10th percentile of $37,290 and a 90th percentile of $67,710. Both series count wage-and-salary employees only.

Read those as two labelled views, not one ladder: the offices-of-optometrists row matches your setting, while the all-industry row mixes every kind of employer that bills. Price against the row that matches your practice, then against the local postings you compete with — our research found no citable pay premium for certification or for medical-billing experience in this seat.

If you attach a bonus to the seat, mind how it interacts with overtime. Unless an exemption applies, FLSA overtime runs at not less than 1.5 times an employee's regular rate for hours over 40 in a workweek. A bonus announced in advance — a production or collections target, for example — is part of that regular rate for non-exempt staff (29 CFR 778.211). Bonuses whose payment and amount the employer decides at its sole discretion near the end of the period, with no prior promise, are the exception. Confirm wage-hour questions with the DOL Wage and Hour Division or employment counsel.

Disclose the range where the law requires it. Washington requires employers with 15 or more employees to disclose the wage scale or salary range and a general description of benefits in each job posting (RCW 49.58.110, effective January 1, 2023). Pay-disclosure rules in other states and cities were not verified one by one in our research, so check the requirement where you post before the listing goes live.

Remote is a real option for this seat: the work runs in your practice management system, clearinghouse and payer portals. Decide in-office versus remote before you post, because it changes the pool you draw from.

Screen remote candidates on the practicalities: reliable access to your systems, a set time when they can reach you or the doctor with questions, and a workspace that protects patient information. Put the arrangement in writing in the offer. Hiring an outside company instead is a different decision with its own rules — the last section below covers the two checks that come first.

Interview against the payer mix in your practice, not against a generic billing resume. Three scenario blocks do the work: one vision-plan, one medical, one receivables.

• Vision plan. Try: "A routine exam claim rejects because the patient's plan eligibility shows inactive — walk me through your week." Strong answers move through an eligibility re-check, a corrected submission and a note to the front desk before the patient books again, and they say who they would tell.
• Medical and Medicare. Try: "A Medicare patient presents with an eye-related medical complaint — what changes about the claim compared with a routine visit?" Listen for the specifics: the diagnosis driving the claim, a different portal or payer, documentation supporting the visit. You are testing whether they know the two workflows differ, not whether they can code your encounter.
• Receivables. Try: "You inherit an aging report with a stack of unworked denials — what do you do first?" Strong answers name a process: sort by dollar size and denial reason, fix the resubmittable claims first, and escalate the pattern to the payer or to you.

If a candidate lists the CPOC or the CPC, verify rather than assume: the CPOC is offered by the AOA's Commission on Paraoptometric Certification and the CPC by AAPC. A quick confirmation with the issuing body tells you the credential is current.

A short paid working trial — an hour in your real billing queue on a normal day — tells you more than a third interview. Keep it paid and supervised: under the FLSA regulations, work that is not requested but is 'suffered or permitted' by the employer is work time (29 CFR 785.11). Our research found no DOL guidance written for optometry working interviews, so confirm an unusual setup with the DOL Wage and Hour Division or employment counsel.

Keep the questions lawful. The EEOC says employers may not ask applicants whether they have a disability, ask medical questions or require a medical exam before making a job offer — you may ask whether and how the applicant can perform the job. Federal EEO laws also bar discrimination based on race, color, religion, sex (including transgender status, sexual orientation and pregnancy), national origin, age (40 or older), disability or genetic information, in job ads and recruiting as well as in interviews. Coverage thresholds and current requirements are not restated here — confirm with the EEOC or employment counsel.

An in-house biller gives the work a person who knows your patients, your EHR and your front desk, and who can pull a rejected claim apart the day it rejects. A billing service replaces that proximity with an outside company that runs billing for multiple practices. Either way, the Medicare billing number stays with the practice: Medicare bars a provider from selling its billing number or privileges or letting another person or entity use them.

Two checks come before any contract with a service. First, Medicare pays a billing agent in the practice's name only if the agent's compensation is not related in any way to the dollar amounts billed or collected and is not dependent on actual collection (42 CFR 424.73(b)(3), applied to physicians and suppliers by 424.80(b)(5)). CMS's Claims Processing Manual says those payment conditions do not apply if the agent merely prepares bills for the practice and does not receive and negotiate the checks payable to it (Ch. 1, 30.2.4). In that arrangement payments can keep flowing to the practice's own account, with the agent drawing its fee from those funds on the practice's instructions (30.2.5). Second, under HIPAA an outside company handling billing that involves patient information is a business associate, and the practice must have a written business associate agreement with it (45 CFR 164.502(e)(2), 164.504(e)).

Confirm Medicare billing-agent questions with CMS or your Medicare administrative contractor, and read any service contract with a healthcare attorney. The full tradeoffs — cost structure, control, staffing and the hybrid arrangements in between — are compared in our guide to in-house vs outsourced billing.

And if the decision is to hire, the case for the seat is the queue: claims that get worked the day they reject, denials that get fixed rather than written off, and a receivables list someone actually owns. For employer-side guides beyond this role, start from hiring for your optometry practice.

This page is employer information, not medical, clinical, licensing, billing, coding or legal advice. Confirm Medicare billing-agent questions with CMS, HIPAA questions with your own compliance advisor, and any billing-services contract with a healthcare attorney.