Denials Management & Appeals Manager
New
United StatesContractManager
Salary93 USD per hour
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Job Details
- Languages
- English
- Experience
- 5+ years
- Required Skills
- Data AnalysisEHR
Requirements
- 5+ years of experience in denials management, appeals, or revenue cycle operations.
- At least 2 years in a management role.
- Deep knowledge of CARC/RARC denial codes, payer denial patterns, and appeal strategies.
- Strong understanding of clinical and technical appeal processes including peer-to-peer and external reviews.
- Experience with denial analytics platforms and revenue cycle reporting tools.
- Proficiency with EHR systems and billing platforms.
- Exceptional written and verbal English communication skills.
- High attention to detail with the ability to evaluate appeal quality and identify errors in AI-generated content.
Responsibilities
- Lead denials management and appeals operations.
- Oversee the identification, categorization, and resolution of claim denials.
- Evaluate AI-generated appeal letters, denial root cause analyses, and denial prevention recommendations for accuracy.
- Analyze denial trends by payer, denial code (CARC/RARC), and category to identify systemic root causes.
- Develop and manage clinical and technical appeal strategies across multiple payer types.
- Coordinate with clinical, coding, billing, and compliance teams to implement denial prevention initiatives.
- Monitor denial management KPIs including denial rates, appeal overturn rates, revenue recovery, and days in A/R.
- Ensure compliance with payer appeal requirements, CMS regulations, and timely filing deadlines.
- Annotate AI outputs and provide structured feedback to support AI training datasets.
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