About this role
Role Overview
Help advance healthcare AI by evaluating tools that support denial prevention, appeal writing, and root-cause analysis. Your expertise in payer denial patterns, clinical and technical appeals, and denial management analytics will inform AI workflows designed to lower denial rates and improve revenue recovery.
Key Responsibilities
- Lead denials management and appeals operations, including identifying, categorizing, and resolving claim denials.
- Assess AI-generated appeal letters, denial root-cause analyses, and prevention recommendations for accuracy and effectiveness.
- Analyze denial trends by payer, CARC/RARC code, and denial category to identify systemic causes.
- Create and manage clinical and technical appeal strategies across commercial, Medicare, and Medicaid payers.
- Partner with clinical, coding, billing, and compliance teams on denial-prevention initiatives.
- Track denial rates, appeal overturn rates, revenue recovery, and days in accounts receivable.
- Manage the appeals calendar to meet payer and regulatory submission deadlines.
- Maintain compliance with payer appeal requirements, CMS regulations, and timely filing rules.
- Annotate AI outputs and provide structured feedback for AI training datasets.
Qualifications
- At least 5 years of experience in denials management, appeals, or revenue cycle operations, including 2 or more years in a management role.
- Deep knowledge of CARC/RARC denial codes, payer denial patterns, and appeal strategies for commercial, Medicare, and Medicaid plans.
- Strong understanding of clinical and technical appeals, including peer-to-peer and external reviews.
- Experience with denial analytics platforms, revenue cycle reporting tools, EHR systems, and billing platforms.
- Exceptional written and verbal English communication skills.
- Strong attention to detail and the ability to assess appeal quality and identify errors in AI-generated denial-management content.
Preferred Qualifications
- CPC, CCS, CRCR, or CHFP certification.
- Experience with AI-assisted denial-management platforms such as Waystar, Experian Health, or Nthrive.
- Background in complex clinical appeals involving medical necessity, experimental or investigational treatment, or level-of-care denials.
- Comfort using AI tools and evaluating AI-generated appeal and denial content.
- Experience presenting denial-management performance to revenue cycle leadership.
Work Terms
- Remote, hourly engagement.
- Opportunity to contribute to high-impact healthcare AI work alongside an AI research organization.
Compensation
$70 to $93 per hour.