Medical Biller

Description

Full time, 36 - 40 hours per week

Working Hours: Flexible work week option available

Our practice, Dermatology Associates of Rochester, located in Rochester NY, is a fast-moving, high-performing, multi-discipline practice with Dermatology, Plastic Surgery, Mohs Surgery, Allergy and Immunology, and a Cosmetic Center. Our experienced Board-Certified dermatologists, Mohs and plastic surgeons, skin care specialists, estheticians, and researchers are dedicated to bringing an unmatched level Total Skin Care, offering some of the most advanced skin treatments available, in a Boutique setting.

Job Summary

The primary function of this role is managing our pharmacy benefit medication process, including biologics, through the Forus platform. The Medical Billing Specialist will be responsible for keeping medication requests moving from prescription to approval. That includes reviewing provider visit notes to confirm the documentation supports each request, understanding which medications are on or off an insurer’s formulary, and knowing what extra steps non-formulary medications require.

Communication and follow-up are large parts of the job. This person will regularly work with providers, clinical staff and specialty pharmacies to coordinate prescriptions, track the status of pending requests, and resolve problems that delay a patient’s access to medication. They should be detail-oriented, organized enough to manage many open cases at once, and persistent in following up with pharmacies and insurers. Supporting the broader billing team with charge entry, insurance verification, and claim follow-up is part of the role, but the main function remains the pharmacy benefit and biologics workflow.

Essential Responsibilities

• Enter medical claim charges accurately and in a timely manner
• Manage accounts receivable and follow up on outstanding balances
• Verify patient insurance eligibility using online payer portals
• Research and resolve claim denials and rejections
• Assist patients and coworkers with billing-related questions
• Coordinate medication authorizations through our authorization platform

Requirements

Minimum Qualifications

• High school diploma or equivalent required.
• Familiarity with insurance company processes and terminology preferred.
• Comfortable with computers and able to quickly learn new software programs required.
• Friendly, professional demeanor and strong communication skills is a must.
• Prior medical office experience is a plus, but not required.
• This position is primarily sedentary and performed in an office setting. Must be able to sit for extended periods while working at a computer, communicate clearly, both verbally and in writing, occasionally stand, walk, bend, or reach, lift and/or move up to 10-15 pounds and have visual acuity sufficient to read documents and view a computer screen for extended periods.