Certified Medical Biller - ModMed EMA REQUIRED

Working Environment & Core Schedule

* Schedule: Monday – Friday, 8:00 AM – 5:00 PM EST (US Eastern Standard Time)
* Core EHR/Billing System: ModMed (Modernizing Medicine / EMA)
* Camera-On Shift Requirement: Agreement and ability to maintain an active, camera-on presence throughout the entire 8-hour shift—required for efficiency, real-time communication, and seamless collaboration with the team of virtual assistants supporting the practice.

Top 3 Daily Tasks

1. Dermatology Coding & Claim Auditing: Review and audit CPT, ICD-10, and HCPCS codes for medical, surgical, and cosmetic procedures prior to clearinghouse submission.
2. Denials, Appeals & Reconsiderations: Investigate rejected or denied claims, correct coding/modifier errors, submit clean claims, and file formal appeals.
3. Payer Follow-Up & Claims Resolution: Conduct proactive follow-up on unpaid or underpaid claims with commercial and government carriers to maintain cash flow.

Core Responsibilities

* Code Verification & Auditing: Audit provider documentation to verify CPT, ICD-10, and HCPCS coding for accuracy, medical necessity, and compliance before billing.
* Complex Modifier Application: Apply and audit specialty modifiers (e.g., 25, 59, XS, XE, XP, XU) to prevent bundling and procedure-to-procedure (PTP) denials.
* Denial Investigation & Resolution: Perform root-cause analysis on claim rejections, revise coding, attach necessary clinical documentation, and resubmit claims promptly.
* Appeals Management: Draft and submit formal reconsideration letters and clinical appeals for complex or high-value denials.
* ModMed Workflow Oversight: Navigate ModMed's billing queues, claim scrubbers, and ERA posting modules to keep practice A/R current.
* Collaborative Remote Team Engagement: Maintain active video connection throughout the shift to facilitate immediate communication, team syncs, and operational alignment with co-VAs.

Requirements

Required Qualifications

* Certification: CPB (Certified Professional Biller) or CBCS (Certified Billing and Coding Specialist) or CMRS (Certified Medical Reimbursement Specialist) Certification
* Specialty Billing Background: Proven medical billing experience specifically supporting a Dermatology practice.
* Dermatology Coding Command: Solid proficiency in dermatology-specific CPT, ICD-10, and HCPCS coding guidelines.
* Advanced Modifier Mastery: Deep, practical familiarity with complex dermatology modifiers (e.g., Modifier 25, 59, XS/XE/XP/XU).
* Claims & Denials Expertise: End-to-end experience submitting clean claims, troubleshooting rejections, and filing formal appeals.
* Camera & Workstation Compliance: Commitment to maintaining an active camera-on presence for the entire 8-hour shift in a private, quiet, HIPAA-compliant workspace.
* Remote Setup: Dedicated PC/Mac, high-speed internet connection, backup internet solution, and a clear USB headset.

Highly Preferred Qualifications

* Software Mastery: Hands-on experience using ModMed (Modernizing Medicine / EMA).
* Leadership Experience: Previous experience as a Billing Supervisor, Team Lead, or Senior Claims Specialist is a strong plus.

Ideal Candidate Profile

You are a sharp, analytical dermatology biller who knows ModMed inside and out. You understand how to read provider notes, catch bundling errors, apply X-modifiers with precision, and relentlessly pursue uncollected insurance claims until resolved.