Clinical Operations Appeals Specialist

About AOTI Advanced Oxygen Therapy, Inc. (AOTI) is transforming the future of wound care through breakthrough technologies that improve the lives of patients with chronic non-healing and acute complex wounds. At the heart of our mission is our patented, multimodality Topical Wound Oxygen (TWO2) therapy, the only device of its kind proven effective in both Randomized Controlled Trials (RCTs) and Real-World Evidence (RWE) studies. TWO2 has delivered exceptional clinical outcomes, including an 88% reduction in hospitalizations and a 71% reduction in amputations among patients with Diabetic Foot Ulcers (DFUs) over 12 months. In addition to TWO2, we offer the NEXA™ NPWT System, an innovative, multi-week, multi-patient Negative Pressure Wound Therapy (NPWT) device designed to deliver the clinical benefits of traditional durable systems with the convenience and simplicity of disposable solutions. The NEXA System is portable, easy to operate, and cost-effective—making advanced wound care more accessible across diverse care settings, from hospitals to the home. Backed by a world-class international leadership team and a robust global infrastructure, AOTI offers a unique opportunity to make a meaningful impact in healthcare. If you're driven by purpose and want to be part of a company that’s transforming wound care, we’d love to hear from you. Why We’re Hiring As demand for our TWO2 therapy continues to grow, we are expanding our team to ensure we maintain the highest standards of patient care. We are looking for compassionate and motivated individuals to join us in delivering life-changing therapy to more patients across the country. Position Summary The Clinical Operations Appeals Specialist is a national reimbursement and clinical documentation specialist responsible for leading insurance appeal activities across the United States. This role serves as the clinical and reimbursement expert for denied claims, partnering closely with physicians, wound consultants, market access, revenue cycle, and operational teams to develop compelling, evidence-based appeals that improve patient access to TWO2 therapy. Location: Remote Employment Type: Full-Time (Remote) Benefits In addition to competitive pay, we offer a comprehensive benefits package that includes: Full benefits with a company-sponsored stipend 401(k) with company match Company-paid Basic Life, AD&D, Short-Term, and Long-Term Disability Insurance 11 Paid Holidays + 2 Floating Holidays Paid Vacation and Sick Time Paid Volunteer Time Off to give back to your community Employee Referral Bonuses Car allowance, fuel reimbursement, and corporate discounts Key Responsibilities • Serve as the national subject matter expert for all insurance denials and appeals strategy involving Commercial, Medicare, Medicaid, Managed Medicaid, Workers' Compensation, and other governmental payers. • Independently assess complex denials and determine the most appropriate appeal strategy based on clinical evidence, payer policy, reimbursement guidelines, and patient-specific circumstances. • Develop persuasive, evidence-based appeal packages including Letters of Medical Necessity, clinical summaries, supporting literature, payer-specific documentation, and physician recommendations. • Exercise independent judgment in prioritizing national appeal inventory to maximize reimbursement success and patient access. • Identify emerging payer trends and proactively develop strategies to decrease the number of denials and improve overturn rates. • Perform comprehensive clinical reviews to evaluate the strength of medical necessity and identify opportunities to improve reimbursement outcomes. • Independently determine documentation deficiencies and collaborate directly with physicians, wound consultants, and clinical staff to obtain clinically meaningful information. • Recommend documentation enhancements that strengthen future authorizations and appeals while ensuring compliance with payer requirements. • Evaluate complex patient histories, wound progression, comorbidities, and treatment response to support reimbursement decisions. • Function as a strategic advisor to field sales team regarding reimbursement strategy and complex patient access issues. • Provide ongoing education and consultation to regional leadership teams on payer trends, documentation best practices, appeal strategy, and reimbursement updates. • Participate in leadership meetings to review market trends, identify barriers to access, and develop national solutions. • Build collaborative relationships across departments to improve organizational effectiveness and patient outcomes. • Lead continuous improvement initiatives designed to increase appeal success rates and reduce reimbursement delays. • Develop standardized appeal templates, documentation tools, workflows, educational resources, and best practices. • Recommend policy and workflow enhancements based on payer trends, denial analysis, and operational data. • Support implementation of new reimbursement initiatives and organizational priorities. • Develop and deliver educational programs for sales leadership, wound consultants, physicians, and internal operational teams. • Serve as an internal resource for complex reimbursement questions and medical necessity interpretation. • Coach field teams on documentation strategies that improve payer acceptance while maintaining compliance. • Assist in development of national reimbursement training programs and educational materials. • Independently determine appeal strategy based on payer requirements and clinical evidence. • Recommend escalation pathways for complex reimbursement cases. • Exercise discretion in evaluating medical necessity documentation and identifying opportunities for improvement. • Prioritize national workload based on organizational priorities and patient need. • Make recommendations to leadership regarding reimbursement strategy, payer engagement, and process improvements. Qualifications & Skills • Licensed healthcare professional preferred (RN, BSN, LPN/LVN, PT/PTA, OT/COTA, MSW, or comparable clinical background). • Minimum of 3 years of progressive experience in healthcare reimbursement, utilization management, appeals, prior authorization, case management, or clinical documentation review. • Minimum of 2 years of wound care or advanced wound therapy experience. • Demonstrated expertise interpreting payer policies and applying clinical judgment to reimbursement decisions. • Experience independently managing complex projects and competing priorities. • Strong analytical, organizational, and problem-solving skills. • Exceptional written communication with demonstrated ability to develop persuasive medical documentation. Competencies • Strategic thinking • Independent decision-making • Clinical judgment • Medical necessity interpretation • Insurance reimbursement expertise • Appeals strategy development • Clinical documentation optimization • Leadership influence without direct authority • Executive-level written communication • Relationship management • Process improvement • Project management • Organizational agility • Continuous learning Physical Demands Occasionally required to sit. Occasionally required to walk. Occasionally required to use hands to finger, handle, or feel. Occasionally required to reach with hands and arms. Occasionally required to talk or hear. Occasionally required to bend, lift or climb. Occasionally required to lift up to (50 pounds or greater). Finger dexterity required. Hand coordination required. Specific vision abilities required for this job include close vision, distance vision, ability to adjust or focus. Work Environment Exposure to adverse conditions. Exposure to moving mechanical parts. Exposure to high, precarious places. Exposure to outside weather conditions. Exposure to fumes or airborne particles. Possible risk of electrical shock. Protective clothing or equipment is required including gloves, covered shoes, protective eyewear. Equal Opportunity Employer Advanced Oxygen Therapy, Inc. is an Equal Employment Opportunity Employer and does not discriminate against applicants or employees on the basis of race, color, religion, creed, national origin, ancestry, disability that can be reasonably accommodated without undue hardship, sex, sexual orientation, gender identity, age, citizenship, marital or veteran status, or any other legally protected status. Data Privacy Notice We collect and use personal information you provide in your application, such as your name, contact details, and professional experience, to evaluate your qualifications and manage our recruiting process. We may also obtain information from publicly available sources or referrals in connection with recruiting activities. We retain this information for a limited period in accordance with applicable laws and our internal policies. You may request access to, correction of, or deletion of your personal information at any time by contacting us at [email protected] . Join Us Join AOTI and help us grow our impact—one patient at a time