Dermatology Biller & Coder

Job Description

Job Description

Description:

The Dermatology Biller & Coder is responsible for accurate coding, billing, claims management, payment review, and accounts receivable follow-up for a busy dermatology practice. This position requires strong knowledge of dermatology-specific CPT, ICD-10-CM, HCPCS, modifiers, payer guidelines, and medical necessity requirements.

The ideal candidate will have hands-on experience with medical, surgical, and procedural dermatology billing and will be comfortable managing claims from initial coding and submission through payment or final resolution.

 
Essential Duties and Responsibilities:

• Review provider documentation and assign accurate CPT, ICD-10-CM, HCPCS, and modifier coding.
• Review and code dermatology services including office visits, biopsies, excisions, repairs/closures, lesion destruction, cryotherapy, injections, Mohs micrographic surgery, and other dermatologic procedures.
• Apply appropriate modifiers, including modifier 25, 59/X modifiers, 24, 57, 58, 78, 79, LT/RT and other applicable modifiers.
• Review claims for NCCI edits, bundling issues, medical necessity, diagnosis-to-procedure compatibility, and payer-specific requirements.
• Review Mohs claims for proper coding, documentation, stages, blocks, repairs, and related services.
• Review medication and biologic billing, including applicable HCPCS/J-codes, units, NDC information, and documentation requirements.
• Submit accurate and timely claims to Medicare, Medicaid/Medi-Cal, commercial insurance plans, HMOs, PPOs, and other contracted payers.
• Review clearinghouse and claim-edit reports and correct rejected claims promptly.
• Monitor unpaid and outstanding claims and actively work A/R aging reports.
• Investigate denied, rejected, or underpaid claims and determine the appropriate corrective action.
• Prepare corrected claims, reconsiderations, and appeals with supporting documentation when necessary.
• Review EOBs and ERAs for appropriate reimbursement, contractual adjustments, denials, and underpayments.
• Identify recurring denial trends and communicate findings to management and appropriate staff.
• Verify that required referrals and authorizations are present when applicable before billing services.
• Review patient account balances to ensure financial responsibility is assigned appropriately after insurance adjudication.
• Communicate professionally with insurance companies, providers, clinical staff, front-office staff, and patients regarding billing matters.
• Query providers when documentation is incomplete or does not support the services being billed.
• Maintain detailed documentation of billing follow-up and payer communications.
• Meet timely filing, appeal, and payer follow-up deadlines.
• Maintain patient confidentiality and comply with HIPAA, CMS, payer, and practice policies.
• Stay current with annual CPT, ICD-10-CM, HCPCS, Medicare, NCCI, and payer-policy changes affecting dermatology.
• Perform additional billing, coding, auditing, and revenue-cycle duties as assigned.

These responsibilities reflect the full-cycle nature of a dermatology billing/coding role, including coding, clean-claim submission, denial resolution, A/R management, payment reconciliation, and identifying recurring reimbursement problems.   

• Minimum 2–3 years of medical billing and coding experience preferred, with dermatology experience strongly preferred.
• Demonstrated knowledge of dermatology CPT, ICD-10-CM, and HCPCS coding.
• Experience with Mohs surgery, biopsies, excisions, repairs/closures, lesion destruction, E/M coding, modifiers, and dermatology procedures strongly preferred.
• Knowledge of HCPCS/J-code billing for injectable, biologic, and infusion medications preferred.
• Strong understanding of Medicare, Medi-Cal/Medicaid, commercial insurance, PPO and HMO billing requirements.
• Experience working claim denials, rejections, appeals, corrected claims, underpayments, and aged accounts receivable.
• Knowledge of NCCI edits, modifier rules, medical necessity requirements, timely filing limits, and payer policies.
• Ability to interpret EOBs, ERAs, denial codes, and payer correspondence.
• Experience reviewing clinical documentation for coding accuracy and completeness.
• Experience with Modernizing Medicine (ModMed/EMA) or similar dermatology EHR/practice-management software strongly preferred.
• CPC, CPB, CPCD, CCS, or other recognized coding/billing certification preferred.
• Strong attention to detail and ability to identify coding or reimbursement discrepancies.
• Excellent written and verbal communication skills.
• Ability to communicate professionally with providers regarding documentation and coding concerns.
• Strong organizational, analytical, problem-solving, and follow-through skills.
• Ability to independently prioritize high-dollar, aging, and timely-filing-sensitive claims.
• Ability to maintain confidentiality and comply with HIPAA requirements.
• Dependable, professional, and able to work effectively both independently and as part of a team.

I especially like including ModMed/EMA experience in your posting because that narrows the applicant pool toward someone who can transition into your dermatology billing workflow much faster. Current dermatology billing postings also commonly emphasize hands-on Mohs, J-code, denial-management, A/R, and specialty-EHR experience.