Senior Denials Specialist

This is a fully remote position, open to applicants in Pakistan.

📋 Description

• Oversee high-volume denial queues for various payers, prioritizing based on dollar amount, filing deadlines, and denial types.

• Examine denial patterns and determine root causes across different locations.

• Manage denials in medical, surgical, and cosmetic dermatology, including prior authorizations, medical necessity, coding and bundling issues, and eligibility rejections.

• Correct, re-code, and resubmit claims with comprehensive supporting documentation.

• Elevate systemic billing or coding concerns to leadership.

• Prepare and submit appeals at all levels (first-level, second-level, external review).

• Gather documentation such as medical records, clinical notes, and payer policies.

• Ensure adherence to payer-specific timelines, requirements, and submission methods.

• Monitor appeal status and follow up diligently to safeguard appeal rights.

• Maintain thorough and organized appeal documentation.

• Manage complex and high-value accounts receivable (A/R) using a structured, priority-driven approach.

• Engage with payers via phone and online portals to resolve disputed claims.

• Identify underpayments and initiate recovery through dispute processes.

• Escalate payer-related issues when necessary.

• Keep accurate and complete account documentation.

• Utilize a strong understanding of dermatology CPT, ICD-10, and HCPCS coding.

• Interpret payer coverage policies, including Local Coverage Determination (LCD) and National Coverage Determination (NCD) guidelines.

• Stay informed about updates in CMS and payer policy changes.

• Assist the billing team with complex denial situations.

• Track denial outcomes and contribute to trend reporting.

• Collaborate with front-end teams to minimize upstream denial causes.

• Clearly communicate findings to leadership.

⛳️ Requirements

• Minimum of 3 years of medical billing experience with a strong emphasis on denials and appeals.

• Demonstrated experience in dermatology, specialty, or multi-location billing environments.

• In-depth knowledge of denial codes, remark codes, and payer adjustments.

• Strong familiarity with CPT, ICD-10, and HCPCS coding.

• Proven success in managing high-dollar and complex A/R accounts.

• Established ability to write and submit effective appeals for multiple payers.

• Experience utilizing medical billing and practice management systems.

• Excellent written communication skills for appeals and documentation.

🏝️ Benefits

• Full-time position.

• 100% remote work opportunity.

• Starting rate at $10/hour.