Dehesa Dermatology

Description:

The Dermatology Medical Biller & Coder is responsible for accurately coding clinical services, submitting claims, posting payments, and ensuring timely reimbursement. This role plays a critical part in optimizing revenue cycle performance while maintaining compliance with payer guidelines, including Medicare and commercial insurance plans.

Requirements:

Medical Coding

• Assign accurate CPT, ICD-10, and HCPCS codes for dermatology services
• Review provider documentation to ensure coding accuracy and completeness
• Apply appropriate modifiers (e.g., -25, -59, -LT/RT)
• Ensure compliance with NCCI edits and payer-specific policies
• Identify documentation gaps and communicate with providers

Charge Entry

• Enter charges into the practice management system (e.g., EMA)
• Verify services align with documentation and scheduled visit type
• Ensure correct provider, location, and insurance selection

Claims Submission

• Prepare and submit clean claims to insurance payers
• Review and correct claim rejections or front-end edits
• Monitor claim status and ensure timely filing

Payment Posting

• Post insurance payments (ERA/EOB) and patient payments
• Apply contractual adjustments accurately
• Identify underpayments and discrepancies

Accounts Receivable (A/R) Follow-Up

• Work denied or unpaid claims
• Investigate denials (authorization, medical necessity, coding errors)
• Submit appeals and corrected claims as needed
• Follow up with payers to ensure reimbursement

Compliance & Auditing

• Maintain compliance with:
  • CMS (Medicare) guidelines
  • Commercial payer policies
• Participate in internal audits to ensure coding accuracy
• Stay updated on coding changes and dermatology billing updates

Dermatology experience preferred .