Senior Denials Specialist

We are seeking an experienced and analytically sharp Senior Denial & Appeals Specialist to take ownership of complex claim denials, manage appeals end-to-end, and drive recovery on high-dollar and high-priority accounts across a multi-location dermatology practice.

This is a senior-level individual contributor role for a billing professional who understands denial workflows deeply, navigates payer-specific processes with precision, and produces measurable recovery outcomes.

If you have proven experience in dermatology or specialty medical billing, strong appeal-writing ability, and a disciplined approach to managing aging A/R — this role is built for you.

🔍 What You Will Own

Denial Management

• Manage high-volume denial queues across multiple payers, prioritizing by dollar value, filing deadlines, and denial type
• Analyze denial trends and identify root causes across locations

Handle medical, surgical, and cosmetic dermatology denials including

• Prior authorization
• Medical necessity
• Coding and bundling issues
• Eligibility rejections
• Correct, re-code, and resubmit claims with complete supporting documentation
• Escalate systemic billing or coding issues to leadership

Appeals Execution

Prepare and submit appeals across all levels (first-level, second-level, external review)
Compile documentation including medical records, clinical notes, and payer policies
Ensure compliance with payer-specific timelines, requirements, and submission channels
Track appeal status and follow up consistently to protect appeal rights
Maintain detailed and organized appeal documentation
High-Dollar & Complex A/R
Work complex and high-value A/R accounts using a structured, priority-based approach
Engage payers via phone and portals to resolve disputed claims
Identify underpayments and initiate recovery through dispute processes
Escalate payer issues when required
Maintain accurate and complete account documentation
Payer & Coding Expertise
Apply strong knowledge of dermatology CPT, ICD-10, and HCPCS coding
Interpret payer coverage policies including LCD and NCD guidelines
Stay updated on CMS and payer policy changes
Support the billing team with complex denial scenarios
Reporting & Collaboration
Track denial outcomes and contribute to trend reporting
Partner with front-end teams to reduce upstream denial drivers
Communicate findings clearly to leadership

Requirements

✅ Required Qualifications
3+ years of medical billing experience with strong focus on denials and appeals
Proven experience in dermatology, specialty, or multi-location billing environments
Deep understanding of denial codes, remark codes, and payer adjustments
Strong working knowledge of CPT, ICD-10, and HCPCS
Demonstrated success handling high-dollar and complex A/R accounts
Proven ability to write and submit effective appeals across multiple payers
Experience using medical billing and practice management systems
Strong written communication skills for appeals and documentation
⭐ Preferred Qualifications
Experience in dermatology, plastic surgery, or aesthetics billing
Familiarity with Availity, Waystar, or similar clearinghouses
Experience with EHR platforms such as EMA (Modernizing Medicine) or Nextech
CPC, CPMA, or related certification
Experience identifying and recovering underpayments through contract analysis

Benefits

Role Details

Full-time

100% Remote

Rate starts at $10/hour

🕐 Interview Scheduling Notice

Initial interviews will be conducted within US Mountain Standard Time (MST), between 3:00 AM and 1:00 PM MST.

We sincerely appreciate your flexibility in accommodating this schedule.

🔒 Data Privacy Statement

By applying, you consent to being contacted via the contact information provided in your application for recruitment purposes only.

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