Senior Denials Specialist

• 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

• 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

• 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

• 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

• 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

• 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

• 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

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