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
Requirements
This is a full time role
Rate starts at $10/hr
100% Remote
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