Senior Denials Specialist

<h3>Position Overview </h3><p>We are seeking an experienced and analytically sharp Senior Denial &amp; 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. </p><p>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. </p><h3>Key Responsibilities </h3><h3>Denial Management </h3><ul><li>Manage a high-volume denial workqueue across multiple payers, prioritizing by dollar amount, timely filing risk, and denial reason </li></ul><ul><li>Analyze denial patterns and root causes across all 9 locations to identify systemic billing, coding, or eligibility issues </li></ul><ul><li>Work medical, cosmetic, and surgical dermatology denials including prior authorization, medical necessity, coding, bundling, and eligibility-related rejections </li></ul><ul><li>Correct and resubmit claims with accurate documentation, updated coding, and supporting clinical information </li></ul><ul><li>Identify and escalate trends that require upstream process corrections to billing leadership </li></ul><h3>Appeals </h3><ul><li>Prepare, write, and submit clinical and administrative appeals to insurance payers at all levels — first-level, second-level, and external review </li></ul><ul><li>Gather and compile supporting documentation including medical records, clinical notes, prior authorization records, and payer-specific coverage policies </li></ul><ul><li>Research payer-specific appeal requirements, deadlines, and submission methods to ensure compliance </li></ul><ul><li>Track appeal status and follow up aggressively within payer timelines to protect appeal rights </li></ul><ul><li>Maintain organized appeal records with detailed documentation of submissions, responses, and outcomes </li></ul><h3>High-Dollar &amp; Complex A/R </h3><ul><li>Work assigned high-dollar and complex accounts receivable accounts with a strategic, prioritized approach </li></ul><ul><li>Contact payers directly via phone and provider portals to resolve disputed or stalled claims </li></ul><ul><li>Identify underpayments and contractual discrepancies and initiate recovery through appropriate dispute processes </li></ul><ul><li>Escalate accounts to the RCM Manager when payer behavior warrants further action or legal review </li></ul><ul><li>Document all account activity, payer communications, and resolution steps clearly in the billing system </li></ul><h3>Payer &amp; Coding Knowledge </h3><ul><li>Apply strong working knowledge of dermatology-specific CPT, ICD-10, and HCPCS codes across medical, surgical, and cosmetic service lines </li></ul><ul><li>Understand payer-specific coverage policies for dermatology, including LCD and NCD guidelines </li></ul><ul><li>Stay current on payer policy changes, CMS updates, and coding guidance that affect dermatology claim adjudication </li></ul><ul><li>Serve as a technical resource for billing team members on complex denial scenarios and payer-specific requirements </li></ul><h3>Reporting &amp; Collaboration </h3><ul><li>Track denial and appeal outcomes and contribute to monthly denial trend reporting for leadership </li></ul><ul><li>Collaborate with front-end billing staff to correct upstream issues that contribute to denials </li></ul><ul><li>Communicate denial and appeal findings clearly to the RCM Manager and cross-functional team members </li></ul><h3>Required Qualifications </h3><ul><li>3 or more years of medical billing experience with a strong focus on denial management and appeals </li></ul><ul><li>Demonstrated experience in dermatology, specialty, or multi-location medical practice billing </li></ul><ul><li>In-depth knowledge of denial reason codes, remark codes, and claim adjustment reason codes across major commercial, Medicare, and Medicaid payers </li></ul><ul><li>Strong working knowledge of dermatology CPT, ICD-10, and HCPCS coding </li></ul><ul><li>Proven ability to write and submit effective appeals across multiple levels and payers </li></ul><ul><li>Experience working high-dollar and complex AR accounts with measurable recovery outcomes </li></ul><ul><li>Proficiency with medical billing and practice management software </li></ul><ul><li>Excellent written communication skills for appeal letters, payer correspondence, and internal reporting </li></ul><h3>Preferred Qualifications </h3><ul><li>Experience billing for a multi-location dermatology, plastic surgery, or aesthetics practice </li></ul><ul><li>Familiarity with Availity, Waystar, or similar clearinghouse platforms </li></ul><ul><li>Experience with EHR and billing platforms used in dermatology such as Modernizing Medicine (EMA), Nextech, or similar </li></ul><ul><li>CPC, CPMA, or other relevant billing or coding certification </li></ul><ul><li>Experience identifying and recovering underpayments through payer contract analysis </li></ul><h3>Requirements</h3><h3>This is a full time role</h3><h3>Rate starts at $10/hr</h3><h3>100% Remote</h3><p>Originally posted on <a href="https://himalayas.app">Himalayas</a></p>