Senior Denials Specialist
R
Remote RavenDermatology
Pakistan. Philippines. KenyaFull-TimeSenior
SalaryAt least 10 USD per hour
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Job Details
- Experience
- 3 or more years
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 EHR and billing platforms used in dermatology 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)
Responsibilities
- 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
- Prepare, write, and submit clinical and administrative appeals to insurance payers at all levels
- Gather and compile supporting documentation including medical records, clinical notes, prior authorization records, and payer-specific coverage policies
- Work assigned high-dollar and complex accounts receivable accounts with a strategic, prioritized approach
- Apply strong working knowledge of dermatology-specific CPT, ICD-10, and HCPCS codes
- Stay current on payer policy changes, CMS updates, and coding guidance that affect dermatology claim adjudication
- Track denial and appeal outcomes and contribute to monthly denial trend reporting for leadership
- Communicate denial and appeal findings clearly to the RCM Manager and cross-functional team members
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