Senior Denials Specialist

14 hours, 44 minutes ago
Full-time
Senior
Operations
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

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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