Resolution Rcm Denials Specialist Jobs (NOW HIRING)

New York City's Largest Dermatology Practice

We're a full-service dermatology practice with 50+ locations across Manhattan, Brooklyn, Queens and Long Island. Now Delaware and Philly too!

The Customer Service Representative (CSR) provides superior customer service while resolving inbound billing inquiries related to dermatology services. The role handles inquiries via phone, email, and EMR-tasked billing requests, assists patients with billing questions, and ensures accurate interpretation of Explanation of Benefits (EOBs), payment postings, and claim denials. The CSR collaborates with the Revenue Cycle team and Ops team to support timely resolution, maintain high patient satisfaction, and improve financial outcomes for the dermatology practice.

Key Responsibilities:

• Manage inbound and outbound inquiries related to dermatology billing via phone, secure email, and EMR-tasked messaging.
• Respond to patient calls and inquiries regarding charges, balances, payment arrangements, and EOB details with professionalism and empathy.
• Review and interpret Explanation of Benefits (EOBs) and remittance advice to determine patient responsibility and correct posting of payments.
• Verify patient demographics, insurance coverage, and eligibility as needed to resolve billing questions and prevent delays.
• Process and/or coordinate payment postings, refunds, adjustments, and write-offs in accordance with policy.
• Investigate claim denials and underpayments; identify root causes and communicate resolution steps to patients and internal teams.
• Collaborate with front desk, clinical staff, and coders to obtain required documentation or clarifications for billing questions.
• Resolve EMR-tasked billing items (e.g., billed-in-error notes, re-billing requests, pre-authorization/authorization tracking as applicable) with accuracy and timeliness.
• Communicate payment plans, balance notifications, and patient financial responsibility clearly and professionally.
• Maintain knowledge of dermatology-specific procedures, CPT/HCPCS codes, and associated payer rules relevant to the practice.
• Ensure compliance with HIPAA and all applicable privacy and security requirements during patient communications and data handling.
• Document interactions and resolutions in the Electronic Medical Record (EMR) and revenue cycle systems; maintain complete, accurate, and auditable notes.
• Escalate complex or unresolved issues to the appropriate supervisor or denials specialist in a timely manner.
• Contribute to process improvement by identifying trends in patient inquiries, denial patterns, and payment bottlenecks; propose enhancements to policies and workflows.
• Meet or exceed key performance indicators (KPIs) such as first-call resolution, average handle time, patient satisfaction scores, and denial/problem resolution rates.

Required Qualifications:

• High school diploma or equivalent; associate degree or relevant certifications preferred (e.g., HIM, CPC, CPAR, or revenue cycle certification).
• Proven experience in healthcare revenue cycle or medical billing/customer service, preferably in dermatology or outpatient specialty settings.
• Strong understanding of health insurance plans, benefit structures, network rules, copays/coinsurance/deductibles, and managed care terminology.
• Detailed knowledge of payment posting processes, coding basics (CPT/HCPCS/ICD-10), denials management, and Explanation of Benefits (EOBs).
• Experience handling EMR systems and billing tools; proficient with payment posting, eligibility verification, and patient communication modules.
• Excellent verbal and written communication skills; ability to explain complex billing concepts in a patient-friendly manner.
• Knowledge of HIPAA requirements and strong commitment to patient privacy and data security.
• Ability to work cross-functionally with front desk staff, clinical teams, and revenue cycle colleagues.

Preferred Qualifications:

• Experience in dermatology or cosmetic dermatology revenue cycles.
• Knowledge of payer-specific rules for dermatology procedures, pre-authorization, and post-treatment billing.
• Bilingual abilities (e.g., English/Spanish) to support a diverse patient population.

Key Competencies:

• Customer Service Excellence
• Revenue Cycle Knowledge
• Insurance & Benefit Literacy
• Denials & Remediation
• Communication Skills (verbal and written)
• Problem Solving and Critical Thinking
• Data Entry and Documentation Quality
• HIPAA Compliance
• Collaboration and Teamwork
• Time Management and Multitasking

Benefits:

• Excellent Benefits Package (medical, dental, vision, 401K)
• 120 hours of Sick /Vacation time; Paid holidays
• Access to Care.com to support childcare, senior care, pet care, and other family needs.
• Exclusive discounts on select cosmetic services.

Compensation: $66,300