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Senior Denials Specialist

Administrative AssistantAdministrative AssistantFull TimeRemoteSeniorTeam 11-50H1B No SponsorCompany SiteLinkedIn

Location

South Africa

Posted

47 days ago

Salary

0

Seniority

Senior

English

Job Description

Senior Denials Specialist

Remote Raven

Senior Denial & Appeals Specialist (Dermatology Billing | Remote) šŸ’° Starting at $10/hour | Full-Time | 100% Remote We are seeking an experienced and analytically sharpĀ Senior Denial & Appeals SpecialistĀ to take ownership of complex claim denials, manage appeals end-to-end, and drive recovery on high-dollar and high-priority accounts across a multi-location dermatology practice. This is aĀ senior-level individual contributor roleĀ for a billing professional who understands denial workflows deeply, navigates payer-specific processes with precision, and produces measurable recovery outcomes. If you have proven experience inĀ dermatology or specialty medical billing, strong appeal-writing ability, and a disciplined approach to managing aging A/R — this role is built for you. šŸ” What You Will Own Denial Management - Manage high-volume denial queues across multiple payers, prioritizing by dollar value, filing deadlines, and denial type - Analyze denial trends and identify root causes across locations - Handle medical, surgical, and cosmetic dermatology denials including: - Prior authorization - Medical necessity - Coding and bundling issues - Eligibility rejections - Correct, re-code, and resubmit claims with complete supporting documentation - Escalate systemic billing or coding issues to leadership Appeals Execution - Prepare and submit appeals across all levels (first-level, second-level, external review) - Compile documentation including medical records, clinical notes, and payer policies - Ensure compliance with payer-specific timelines, requirements, and submission channels - Track appeal status and follow up consistently to protect appeal rights - Maintain detailed and organized appeal documentation High-Dollar & Complex A/R - Work complex and high-value A/R accounts using a structured, priority-based approach - Engage payers via phone and portals to resolve disputed claims - Identify underpayments and initiate recovery through dispute processes - Escalate payer issues when required - Maintain accurate and complete account documentation Payer & Coding Expertise - Apply strong knowledge of dermatology CPT, ICD-10, and HCPCS coding - Interpret payer coverage policies including LCD and NCD guidelines - Stay updated on CMS and payer policy changes - Support the billing team with complex denial scenarios Reporting & Collaboration - Track denial outcomes and contribute to trend reporting - Partner with front-end teams to reduce upstream denial drivers - Communicate findings clearly to leadership

Job Requirements

  • āœ… Required Qualifications
  • 3+ years of medical billing experience with strong focus onĀ denials and appeals
  • Proven experience inĀ dermatology, specialty, or multi-location billing environments
  • Deep understanding of denial codes, remark codes, and payer adjustments
  • Strong working knowledge ofĀ CPT, ICD-10, and HCPCS
  • Demonstrated success handlingĀ high-dollar and complex A/R accounts
  • Proven ability to write and submit effective appeals across multiple payers
  • Experience using medical billing and practice management systems
  • Strong written communication skills for appeals and documentation
  • ⭐ Preferred Qualifications
  • Experience in dermatology, plastic surgery, or aesthetics billing
  • Familiarity withĀ Availity, Waystar, or similar clearinghouses
  • Experience with EHR platforms such asĀ EMA (Modernizing Medicine) or Nextech
  • CPC, CPMA, or related certification
  • Experience identifying and recovering underpayments through contract analysis
  • šŸ• Interview Scheduling Notice
  • Initial interviews will be conducted withinĀ US Mountain Standard Time (MST), betweenĀ 3:00 AM and 1:00 PM MST.
  • We sincerely appreciate your flexibility in accommodating this schedule.
  • šŸ”’ Data Privacy Statement
  • By applying, you consent to being contacted via the contact information provided in your application for recruitment purposes only.

Benefits

  • Role Details
  • Full-time
  • 100% Remote
  • Rate starts at $10/hour

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