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Senior Denials Specialist

3 weeks, 1 day ago
Kenya, Pakistan, Philippines
Full-time
Senior
Accountant
Operations
Apply Now
Remote Raven

Remote Raven

Remote Raven connects clients with highly qualified virtual assistants to quickly fill positions, enabling businesses to focus on core activities with no start-up fees.

Professional Services
11-50
View All Jobs 31

Description

  • Manage a high-volume denial workqueue across multiple payers and prioritize accounts 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 involving prior authorization, medical necessity, coding, bundling, and eligibility rejections.
  • Correct and resubmit claims with accurate documentation, updated coding, and supporting clinical information.
  • Prepare, write, and submit first-level, second-level, and external review appeals to insurance payers.
  • Gather and organize supporting documentation such as medical records, clinical notes, prior authorization records, and payer coverage policies.
  • Research payer-specific appeal requirements, deadlines, and submission methods to ensure compliance.
  • Track appeal status and follow up within payer timelines to protect appeal rights.
  • Work high-dollar and complex accounts receivable items using a strategic, prioritized approach.
  • Contact payers by phone and through provider portals to resolve disputed or stalled claims, identify underpayments, and initiate recovery efforts.
  • Document all account activity, payer communications, submission details, and resolution steps in the billing system.
  • Collaborate with billing leadership and front-end staff to correct upstream issues and report denial trends and outcomes.

Requirements

  • 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.
  • Experience billing for a multi-location dermatology, plastic surgery, or aesthetics practice (preferred).
  • Familiarity with Availity, Waystar, or similar clearinghouse platforms (preferred).
  • Experience with dermatology EHR and billing platforms such as Modernizing Medicine (EMA), Nextech, or similar (preferred).
  • CPC, CPMA, or other relevant billing or coding certification (preferred).
  • Experience identifying and recovering underpayments through payer contract analysis (preferred).
  • Full-time availability.
  • 100% remote work setup.

Benefits

  • 100% remote work arrangement.
  • Full-time position.
  • Rate starts at $10/hour.

Interested in this position?

Apply directly on the company website

Apply Now

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