Senior Medical & Dental Billing, Coding & Denial Resolution Specialist

Senior Medical & Dental Billing, Coding & Denial Resolution Specialist

Minimum 7 Years of Experience Required | Full-Cycle Billing | Denial Management | Revenue Recovery

About Clarity Works AI

Clarity Works AI helps medical and dental practices recover outstanding revenue, reduce denials, improve collections, and maintain consistent cash flow.

We manage billing operations for multiple practices, handling everything from claim creation and submission to complex denial resolution and revenue recovery.

Application Requirements

Please include the following with your application:

1. Your years of medical billing experience and dental billing experience, separately.
2. The specialties, procedures, and insurance payers you've worked with.
3. The EHR systems, billing platforms, and clearinghouses you've used.
4. Your experience independently managing multiple client accounts.

Qualified candidates will be required to complete a practical billing and denial resolution assessment before receiving an offer.

About the Role

We're looking for a highly experienced Medical & Dental Billing Specialist with at least 7 years of hands-on experience in full-cycle billing, coding, denial management, and accounts receivable recovery.

We are not looking for someone who only knows how to submit claims. We need someone who understands the entire revenue cycle and has the experience to resolve difficult billing problems, recover unpaid claims, and independently manage client accounts.

The right candidate can build and submit claims from provider documentation, investigate complex denials, interpret payer responses, prepare appeals, challenge incorrect payment decisions, and follow claims through to resolution.

You should also know how to identify problems affecting an account's financial performance. If collections are declining, claims aren't being submitted, or payments are taking too long, we expect you to recognize the issue, investigate it, and take action without waiting for management to intervene.

This position requires someone who is technically strong, organized, resourceful, and accountable for results.

Key Responsibilities

Full-Cycle Medical & Dental Billing and Coding

• Independently manage billing for assigned medical and dental practices.
• Review clinical documentation and create accurate claims from scratch.
• Apply appropriate ICD-10, CPT, HCPCS, CDT codes, and modifiers, as applicable.
• Review documentation to ensure billed services are supported and appropriate reimbursement opportunities are captured.
• Submit clean claims promptly and monitor acceptance.
• Identify missing charges, unbilled visits, incomplete documentation, and claims approaching timely filing deadlines.
• Handle insurance verification, claim corrections, payment posting, and reimbursement reconciliation.
• Review EOBs and ERAs to identify incorrect payments, adjustments, and discrepancies.
• Work with providers to obtain missing documentation, including clinical notes, narratives, X-rays, and other supporting records.

Denial Management, Appeals & Revenue Recovery

This is a major part of the position. We need someone with extensive, hands-on experience working denials and recovering unpaid claims.

• Independently investigate and resolve medical and dental claim denials.
• Understand and interpret denial codes, CARC/RARC codes, EOBs, ERAs, and payer explanations.
• Determine the actual cause of a denial rather than simply correcting and resubmitting claims.
• Prepare and submit corrected claims, reconsiderations, and formal appeals with appropriate supporting documentation.
• Resolve denials involving medical necessity, authorization, eligibility, coordination of benefits, coding, modifiers, bundling, timely filing, and payer processing errors.
• Challenge incorrect payer decisions using payer policies, contract terms, clinical documentation, and applicable billing guidelines.
• Investigate underpayments and identify opportunities to recover additional reimbursement when supported by documentation and contractual terms.
• Follow up with payers, obtain reference numbers, escalate unresolved issues, and track claims until a final resolution is reached.
• Work complex and aged A/R, including claims over 90 and 120 days.
• Identify recurring denial patterns, determine their root causes, and recommend corrections to prevent future denials.
• Recognize when a claim should be corrected, appealed, escalated, or appropriately written off.

We expect you to know how to get difficult claims paid, not simply document that they were denied.

Client Account Ownership & Performance

• Take responsibility for the overall billing health of assigned client accounts.
• Monitor daily claim submissions, rejections, denials, unpaid claims, and collections.
• Actively investigate claims that remain unpaid beyond 14 days, including claims already accepted by the payer.
• Identify unexpected declines in submissions, charges, payments, or collections.
• Review unbilled services regularly to ensure revenue isn't being missed.
• Prioritize work based on financial impact, timely filing deadlines, and account needs.
• Maintain accurate tracking of outstanding claims, follow-up dates, payer responses, and unresolved issues.
• Provide management with clear updates on account performance, problems identified, actions taken, and expected next steps.
• Identify workflow problems and recommend solutions to improve reimbursement and reduce recurring issues.

Problem-Solving, Accountability & Follow-Through

• Independently investigate problems using EHR systems, clearinghouses, payer portals, provider manuals, and other available resources.
• Take initiative to resolve issues rather than waiting for detailed instructions.
• Follow through on outstanding claims and tasks until they are resolved or a documented final determination is reached.
• Escalate issues appropriately, explaining what has already been investigated and what action is needed.
• Communicate directly with insurance companies, providers, and office staff to resolve billing obstacles.
• Identify and address recurring problems rather than repeatedly handling the same issue.
• Keep leadership informed of issues that could affect submissions, collections, or timely filing.
• Take responsibility for assigned accounts and the quality of work performed.

Required Qualifications

Candidates must meet all of the following requirements

• Minimum 7 years of professional, hands-on medical and/or dental billing experience.
• Extensive experience in full-cycle billing, from claim creation through payment posting and reconciliation.
• Strong knowledge of medical and/or dental coding, including the ability to review documentation and create claims independently.
• Proven experience independently resolving complex claim denials, preparing appeals, and recovering unpaid revenue.
• Strong experience working aged A/R and following up directly with insurance companies.
• Ability to interpret EOBs, ERAs, payer denial codes, and reimbursement guidelines.
• Experience identifying denial patterns and addressing underlying billing problems.
• Demonstrated ability to independently manage multiple client accounts.
• Strong understanding of payer requirements, timely filing, authorizations, eligibility, coordination of benefits, and reimbursement rules.
• Proficiency with EHR/EMR systems, practice management software, clearinghouses, and payer portals.
• Strong organizational skills, independent problem-solving ability, and consistent follow-through.
• Ability to communicate clearly with providers, payers, clients, and management.

Preferred: Substantial experience in both medical and dental billing, experience with multiple specialties, and prior employment with a revenue cycle management company.

What Makes Someone Successful in This Role

We're looking for someone who:

• Knows billing and denials. You can create claims, identify coding issues, investigate denials, prepare appeals, and recover payments without needing someone to walk you through the process.
• Takes ownership. You know the status of your assigned accounts and don't wait for someone else to identify problems.
• Finds solutions. When a claim isn't paying, you investigate why, determine the next steps, and keep working toward resolution.
• Follows through. You don't consider a claim handled simply because you called the payer or left a note.
• Recognizes patterns. You notice recurring denials, submission gaps, and payment delays and work to correct the underlying cause.
• Works independently. You know how to research payer requirements, prioritize tasks, and manage multiple accounts without constant supervision.
• Focuses on results. You understand that the goal isn't just to process claims. It's to help practices collect the money they're entitled to receive.

Performance Expectations

Performance will be evaluated based on:

• Timely and accurate submission of billable claims.
• Claim acceptance and rejection rates.
• Denial resolution and successful appeals.
• Recovery of outstanding and underpaid claims.
• Consistent follow-up on claims unpaid beyond 14 days.
• Reduction in aged accounts receivable.
• Identification and prevention of recurring billing issues.
• Overall billing health of assigned accounts.
• Communication, organization, and follow-through.

Who Should Not Apply

This position is not suitable for candidates who:

• Have fewer than 7 years of hands-on billing experience.
• Only have experience submitting claims prepared by others.
• Have limited experience investigating denials or preparing appeals.
• Routinely forward difficult claims to supervisors instead of investigating them.
• Only work claims from assigned task lists without monitoring the overall account.
• Require frequent reminders to follow up on unpaid claims.
• Consider a claim