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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