Denials Management Manager | Remote

Denials Management & Appeals Manager

A contract opportunity to apply deep revenue cycle expertise in evaluating and refining automation tools built for denial prevention, appeal writing, and root cause analysis. This role directly shapes the quality and accuracy of next-generation denial management workflows at the intersection of payer operations and emerging technology.

$93/hr | Contract | Remote

Key Responsibilities

• Oversee end-to-end denials management operations, including denial identification, categorisation by CARC/RARC code and payer type, and resolution tracking across commercial, Medicare, and Medicaid payers
• Evaluate model-generated appeal letters, root cause analyses, and denial prevention recommendations for clinical accuracy, regulatory compliance, and strategic effectiveness
• Analyse denial trends at the payer, code, and category level to surface systemic gaps and drive prevention initiatives in coordination with coding, billing, and compliance functions
• Develop and execute clinical and technical appeal strategies, including peer-to-peer and external review processes, ensuring timely submission within all payer and regulatory deadlines
• Monitor core denial management KPIs denial rate, appeal overturn rate, revenue recovery, and days in A/R and report performance to revenue cycle leadership
• Annotate automation outputs and deliver structured, domain-specific feedback to support model training datasets

Core Requirements

• Demonstrated expertise in denials management, appeals strategy, and revenue cycle operations with a minimum of two years in a management capacity
• Deep command of CARC/RARC denial code frameworks and payer-specific denial patterns across commercial, Medicare, and Medicaid lines
• Proven ability to construct and manage complex clinical appeals, including medical necessity, level of care, and experimental/investigational denials
• Hands-on experience with denial analytics platforms and revenue cycle reporting tools; proficiency with EHR systems and billing platforms
• Ability to critically evaluate appeal quality, identify errors in automation-generated content, and apply consistent quality standards across high-volume output
• Exceptional written English communication skills with precision in documentation and structured feedback

Additional Strengths

• Active certification in CPC, CCS, CRCR, or CHFP
• Prior exposure to automation-assisted denial platforms such as Waystar, Experian Health, or Nthrive
• Track record presenting denial management performance metrics to senior revenue cycle leadership

Applications will be reviewed only via LinkedIn Easy Apply.