Senior Denials Specialist

Position Overview 

We are seeking an experienced and analytically sharp Senior Denial & 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. 

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. 

Key Responsibilities 

Denial Management 

• 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 

• Correct and resubmit claims with accurate documentation, updated coding, and supporting clinical information 

• Identify and escalate trends that require upstream process corrections to billing leadership 

Appeals 

• Prepare, write, and submit clinical and administrative appeals to insurance payers at all levels — first-level, second-level, and external review 

• Gather and compile supporting documentation including medical records, clinical notes, prior authorization records, and payer-specific coverage policies 

• Research payer-specific appeal requirements, deadlines, and submission methods to ensure compliance 

• Track appeal status and follow up aggressively within payer timelines to protect appeal rights 

• Maintain organized appeal records with detailed documentation of submissions, responses, and outcomes 

High-Dollar & Complex A/R 

• Work assigned high-dollar and complex accounts receivable accounts with a strategic, prioritized approach 

• Contact payers directly via phone and provider portals to resolve disputed or stalled claims 

• Identify underpayments and contractual discrepancies and initiate recovery through appropriate dispute processes 

• Escalate accounts to the RCM Manager when payer behavior warrants further action or legal review 

• Document all account activity, payer communications, and resolution steps clearly in the billing system 

Payer & Coding Knowledge 

• Apply strong working knowledge of dermatology-specific CPT, ICD-10, and HCPCS codes across medical, surgical, and cosmetic service lines 

• Understand payer-specific coverage policies for dermatology, including LCD and NCD guidelines 

• Stay current on payer policy changes, CMS updates, and coding guidance that affect dermatology claim adjudication 

• Serve as a technical resource for billing team members on complex denial scenarios and payer-specific requirements 

Reporting & Collaboration 

• Track denial and appeal outcomes and contribute to monthly denial trend reporting for leadership 

• Collaborate with front-end billing staff to correct upstream issues that contribute to denials 

• Communicate denial and appeal findings clearly to the RCM Manager and cross-functional team members 

Required Qualifications 

• 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 

Preferred Qualifications 

• Experience billing for a multi-location dermatology, plastic surgery, or aesthetics practice 

• Familiarity with Availity, Waystar, or similar clearinghouse platforms 

• Experience with EHR and billing platforms used in dermatology such as Modernizing Medicine (EMA), Nextech, or similar 

• CPC, CPMA, or other relevant billing or coding certification 

• Experience identifying and recovering underpayments through payer contract analysis 

This is a full time role

Rate starts at $10/hr

100% Remote