Senior Denials Specialist

Position Overview

We are seeking an experienced and analytically sharp Senior Denial & Appeals Specialist to manage complex claim denials, prepare and submit appeals, and drive resolution on high-dollar and high-priority accounts across our 9-location dermatology practice. This is a senior-level individual contributor role for a billing professional who knows the denial landscape inside and out and can navigate payer-specific processes with confidence and precision.

The ideal candidate has deep experience in dermatology or specialty medical billing, understands how to build a compelling appeal, and knows how to work an aging AR bucket strategically to maximize recovery.

Key Responsibilities

Denial Management

Manage a high-volume denial workqueue across multiple payers, prioritizing by dollar amount, timely filing risk, and denial reason
Analyze denial patterns and root causes across all 9 locations to identify systemic billing, coding, or eligibility issues
Work medical, cosmetic, and surgical dermatology denials including prior authorization, medical necessity, coding, bundling, and eligibility-related rejections
Correct and resubmit claims with accurate documentation, updated coding, and supporting clinical information
Identify and escalate trends that require upstream process corrections to billing leadership

Appeals

Prepare, write, and submit clinical and administrative appeals to insurance payers at all levels — first-level, second-level, and external review
Gather and compile supporting documentation including medical records, clinical notes, prior authorization records, and payer-specific coverage policies
Research payer-specific appeal requirements, deadlines, and submission methods to ensure compliance
Track appeal status and follow up aggressively within payer timelines to protect appeal rights
Maintain organized appeal records with detailed documentation of submissions, responses, and outcomes
High-Dollar & Complex A/R
Work assigned high-dollar and complex accounts receivable accounts with a strategic, prioritized approach
Contact payers directly via phone and provider portals to resolve disputed or stalled claims
Identify underpayments and contractual discrepancies and initiate recovery through appropriate dispute processes
Escalate accounts to the RCM Manager when payer behavior warrants further action or legal review
Document all account activity, payer communications, and resolution steps clearly in the billing system
Payer & Coding Knowledge
Apply strong working knowledge of dermatology-specific CPT, ICD-10, and HCPCS codes across medical, surgical, and cosmetic service lines
Understand payer-specific coverage policies for dermatology, including LCD and NCD guidelines
Stay current on payer policy changes, CMS updates, and coding guidance that affect dermatology claim adjudication
Serve as a technical resource for billing team members on complex denial scenarios and payer-specific requirements
Reporting & Collaboration
Track denial and appeal outcomes and contribute to monthly denial trend reporting for leadership
Collaborate with front-end billing staff to correct upstream issues that contribute to denials
Communicate denial and appeal findings clearly to the RCM Manager and cross-functional team members

Required Qualifications

3 or more years of medical billing experience with a strong focus on denial management and appeals
Demonstrated experience in dermatology, specialty, or multi-location medical practice billing
In-depth knowledge of denial reason codes, remark codes, and claim adjustment reason codes across major commercial, Medicare, and Medicaid payers
Strong working knowledge of dermatology CPT, ICD-10, and HCPCS coding
Proven ability to write and submit effective appeals across multiple levels and payers
Experience working high-dollar and complex AR accounts with measurable recovery outcomes
Proficiency with medical billing and practice management software
Excellent written communication skills for appeal letters, payer correspondence, and internal reporting

Preferred Qualifications

Experience billing for a multi-location dermatology, plastic surgery, or aesthetics practice
Familiarity with Availity, Waystar, or similar clearinghouse platforms
Experience with EHR and billing platforms used in dermatology such as Modernizing Medicine (EMA), Nextech, or similar
CPC, CPMA, or other relevant billing or coding certification
Experience identifying and recovering underpayments through payer contract analysis

Requirements

This is a full time role

Rate starts at $10/hr

100% Remote

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