Senior Denials Specialist

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🔥 10 minutes ago

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Remote Raven

WebsiteLinkedInAll Job Openings

11 - 50 employees

👥 HR Tech

🎯 Recruiter

🤝 B2B

HR Tech • Recruitment • B2B

Remote Raven is a company that connects businesses with highly qualified virtual assistants to fill various roles across multiple industries. They focus on providing professional, college-educated, and well-trained remote workers from the Philippines who can handle diverse tasks, including customer service, bookkeeping, digital marketing, HR, healthcare, and web development among others. Remote Raven ensures that these remote workers are fluent in English and hold relevant degrees or certifications. They offer a simple and affordable recruiting process without start-up fees, aiming to help companies streamline their staffing needs with reliable remote personnel.

📋 Description

• 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, and eligibility rejections • Correct, re-code, and resubmit claims with complete supporting documentation • Escalate systemic billing or coding issues to leadership • 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 • 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 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 • Track denial outcomes and contribute to trend reporting • Partner with front-end teams to reduce upstream denial drivers • Communicate findings clearly to leadership

🎯 Requirements

• 3+ years of medical billing experience with strong focus on denyals and appeals • Proven experience in dermatology, specialty, or multi-location billing environments • Deep understanding of denial codes, remark codes, and payer adjustments • Strong 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 • Strong written communication skills for appeals and documentation

🏖️ Benefits

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