Remote Raven
Healthcare
SeniorDenialsSpecialist
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“Senior Denials Specialist at Remote Raven. Skills: Denial Management, Appeals Execution, High-Dollar & Complex A/R, Payer & Coding Expertise. 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”
What You'll Achieve.
drive recovery on high-dollar and high-priority accounts; produces measurable recovery outcomes; Demonstrated success handling high-dollar and complex A/R accounts; initiate recovery through dispute processes; reduce upstream denial drivers
Industry & Context.
analytically sharp; Analyze denial trends and identify root causes; resolve disputed claims; identify underpayments
What They're Looking For.
Must Have
3+ years of medical billing experience with focus on denials and appeals, Proven experience in dermatology, specialty, or multi-location billing environments, Deep understanding of denial codes, remark codes, and payer adjustments, working knowledge of CPT, ICD-10, and HCPCS, Demonstrated success handling 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, written communication skills for appeals and documentation
Nice to Have
Experience in dermatology, plastic surgery, or aesthetics billing, Familiarity with Availity, Waystar, or similar clearinghouses, Experience with EHR platforms such as EMA (Modernizing Medicine) or Nextech, CPC, CPMA, or related certification, Experience identifying and recovering underpayments through contract analysis
What You'll Do.
Manage high-volume denial queues across multiple payers
prioritizing by dollar value
Analyze denial trends and identify root causes across locations
and cosmetic dermatology denials including: Prior authorization
Coding and bundling issues
Eligibility rejections
and resubmit claims with complete supporting documentation
Escalate systemic billing or coding issues to leadership
Prepare and submit appeals across all levels (first-level
Compile documentation including medical records
Ensure compliance with payer-specific timelines
and submission channels
Track appeal status and follow up consistently to protect appeal rights
Maintain detailed and organized appeal documentation
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
Apply knowledge of dermatology CPT
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
Track denial outcomes and contribute to trend reporting
Partner with front-end teams to reduce upstream denial drivers
Communicate findings clearly to leadership
How You'll Work.
Team & Collaboration
Partner with front-end teams to reduce upstream denial drivers; Support the billing team with complex denial scenarios; Communicate findings clearly to leadership
Communication Scope
written communication skills for appeals and documentation; Communicate findings clearly to leadership
Full Job Description
**Senior Denial & Appeals Specialist (Dermatology Billing | Remote)** 💰 Starting at $10/hour | Full-Time | 100% Remote We are seeking an experienced and analytically sharp **Senior Denial & Appeals Specialist** 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 a **senior-level individual contributor role** 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 in **dermatology or specialty medical billing** , strong appeal-writing ability, and a disciplined approach to managing aging A/R — this role is built for you. **🔍 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 disput
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