Denials and Appeals Specialist

Phothera Phototherapy; Cleveland (OH); A distancia; USD 39.000 - 48.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Monthly bonus opportunity

Fully remote work environment

Opportunity to join growing healthcare

Descripción de la vacante

Phothera is seeking a Denials & Appeals Specialist to own the appeals process for denied and underpaid claims, focusing on medical necessity and payer policy alignment to maximize reimbursement and patient access.

While the role is fully remote, candidates based in or near Beachwood, OH are strongly preferred. This opportunity includes a monthly bonus opportunity and a fully remote work environment within a growing healthcare organization.

Formación

• 3+ years in medical billing, reimbursement, denial management, or revenue cycle operations.
• Experience submitting appeals for medical necessity and payer denials.
• Experience with commercial and government payers.
• Proficiency with Excel, Word, and PDF management.
• Ability to work independently in a remote environment.

Responsabilidades

• Review, analyze, and prioritize denied or underpaid claims.
• Draft, submit, and manage appeals through resolution.
• Prepare appeals for medical necessity, coverage, and payer denials.
• Monitor payer deadlines and escalation requirements.
• Maintain organized workflows for timely submissions.

Conocimientos

Denied claims ownership

Appeals management

Payer policy knowledge

Remote work

Herramientas

Excel

Word

PDF management

Descripción del empleo

Preferred Location:

Candidates based in or near Beachwood, OH are strongly preferred.

Reports To:

Revenue Cycle Manager

Lucas James Talent Partners is partnering with Phothera, a Madison Medical company within Madison Industries, on a direct hire opportunity for a Denials & Appeals Specialist.

This is a remote revenue cycle role focused on ownership of denied and underpaid claims, appeals strategy, payer follow-up, and reimbursement recovery. The ideal candidate brings strong denial management experience, understands payer medical policies and appeal processes, and can independently manage both routine and complex appeals while helping improve patient access to care.

About Phothera

Phothera is part of Madison Medical, the healthcare and life sciences platform of Madison Industries, a global organization focused on building and scaling market-leading businesses.

Phothera is advancing phototherapy to improve outcomes for patients with chronic skin conditions such as psoriasis, eczema, and vitiligo. Their solutions provide a safe, effective, and cost-efficient alternative to traditional therapies, enabling patients to receive treatment in the comfort of their own home.

As the organization continues to grow, Phothera is investing in expanding patient access and reimbursement support. The Denials & Appeals Specialist will play a critical role in ensuring patients receive access to medically appropriate treatment while helping drive reimbursement success across major commercial and government payers.

The Opportunity

Phothera is seeking a Denials & Appeals Specialist to own the appeals process for denied and underpaid claims.

This role will focus heavily on medical necessity and non-covered denials where payer policies may not align with FDA-approved indications and clinical evidence supporting home UV phototherapy. The individual will work closely with internal teams, provider offices, and payer organizations to maximize reimbursement outcomes and support broader market access initiatives.

Success in this position requires more than routine claim follow-up. We are looking for someone who can quickly evaluate denial rationale, understand payer medical policies, prioritize high-impact opportunities, and determine when a case requires a more strategic appeals approach.

The ideal candidate combines strong revenue cycle expertise with critical thinking, organization, and a sense of urgency around reimbursement recovery and patient access.

While the role is fully remote, candidates located in or near Beachwood, OH will receive strong preference.

Key Responsibilities

Denials & Appeals Management

• Review, analyze, and prioritize denied or underpaid claims
• Investigate denial root causes and determine appropriate next steps
• Draft, submit, and manage appeals through resolution
• Prepare and submit appeals for medical necessity, coverage, and payer policy denials
• Maintain organized workflows to ensure timely appeal submission and follow-up
• Monitor payer deadlines and escalation requirements

Payer Strategy & Resolution

• Develop an understanding of payer medical policies and reimbursement requirements
• Manage appeals across Medicare, UnitedHealthcare, Aetna, Cigna, Anthem, Blue Cross Blue Shield, and other major payers
• Identify opportunities to overturn denials through supporting documentation and policy interpretation
• Escalate complex reimbursement issues when appropriate

Provider & Internal Collaboration

• Partner with provider office staff to obtain supporting documentation when necessary
• Work cross-functionally with Revenue Cycle, Intake, Market Access, and Leadership teams
• Support ongoing initiatives focused on improving reimbursement and patient access
• Maintain accurate documentation of all appeal activity and outcomes

Reporting & Process Improvement

• Track appeal outcomes, recovery amounts, and denial trends
• Identify recurring payer challenges and reimbursement opportunities
• Share insights that help improve internal processes and future claim success
• Support continuous improvement initiatives across the revenue cycle function

The Profile

We are seeking a reimbursement and revenue cycle professional who can balance high-volume appeal activity with strategic problem-solving.

Successful candidates are likely to have experience managing denials, appeals, reimbursement follow-up, or complex payer interactions within healthcare, DME, specialty therapies, medical billing, or revenue cycle environments.

Analytical & Detail-Oriented

• Able to quickly assess denial rationale, supporting documentation, and payer requirements

Organized & Process Driven

• Maintains strong follow-up habits and effectively manages competing priorities
• Comfortable owning a denial inventory and driving claims through resolution

Strategic Problem Solver

• Understands when a denial requires routine handling versus deeper investigation and escalation

Patient Access Focused

• Motivated by helping patients gain access to medically appropriate therapies

Compensation:

$28.00-$35.00 per hour

Additional offerings include:

• Monthly Bonus Opportunity: Employees may be eligible for a monthly bonus based on company performance. Bonus availability and amounts are not guaranteed and are subject to change.
• Fully remote work environment
• Opportunity to join a growing healthcare organization focused on improving patient outcomes and access to care

Qualifications

Required

• 3+ years of experience in medical billing, reimbursement, denial management, appeals, or revenue cycle operations, including direct ownership of denied claims and appeals
• Experience preparing and submitting appeals for medical necessity, coverage, or payer policy denials
• Experience working with commercial and/or government payers
• Knowledge of payer portals, claims workflows, EOBs, ERAs, and reimbursement processes
• Strong written communication skills for appeals preparation
• Proficiency with Microsoft Excel, Word, PDF management, and general business systems
• Ability to work independently in a remote environment

Preferred

• Candidates based in or near Beachwood, OH strongly preferred
• Experience with DME, specialty therapies, dermatology, phototherapy, or healthcare reimbursement
• Experience handling medical necessity denials and complex appeals
• Knowledge of Medicare, UnitedHealthcare, Aetna, Cigna, Anthem, and Blue Cross Blue Shield payer processes
• Experience supporting reimbursement efforts within a healthcare provider, manufacturer, specialty therapy, or DME environment

What Success Looks Like

Success in this role will be measured by timely appeal activity, reimbursement recovery, denial resolution, and contribution to patient access initiatives.

Top performers will:

• Quickly become proficient in Phothera's products, reimbursement processes, and systems
• Maintain current and organized appeal inventories
• Successfully overturn denied claims and recover reimbursement revenueIdentify trends and opportunities that improve future claim outcomes
• Support broader market access efforts by helping demonstrate the value of home UV phototherapy through successful appeals and reimbursement outcomes

Equal Opportunity Employer

Phothera is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, age, or any other status protected by applicable federal, state, or local law.