Denials Management and Appeals Manager for AI Systems

Lead the evaluation and improvement of AI tools that automate denial prevention, appeal writing, and root cause analysis. Use your denials management and appeals expertise to validate AI outputs, shape appeal strategies, and reduce denial rates while maximising revenue recovery across payer types.

• Lead denials management and appeals operations, including identification, categorisation, and resolution of claim denials.
• Evaluate AI-generated appeal letters, denial root cause analyses, and denial prevention recommendations for accuracy and effectiveness.
• Analyse denial trends by payer, denial code (CARC/RARC), and denial category to identify systemic root causes.
• Develop and manage clinical and technical appeal strategies across commercial, Medicare, and Medicaid payers.
• 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 accounts receivable.
• Manage the appeals calendar to ensure timely submissions that meet payer and regulatory deadlines.
• Ensure compliance with payer appeal requirements, CMS regulations, and timely filing deadlines.
• Annotate AI outputs and provide structured feedback to support AI training datasets.

• Minimum 5 years of experience in denials management, appeals, or revenue cycle operations, with at least 2 years in a management role.
• Deep knowledge of CARC and RARC denial codes, payer denial patterns, and appeal strategies across commercial, Medicare, and Medicaid payers.
• Strong understanding of clinical and technical appeal processes, including peer-to-peer reviews and external reviews.
• Experience using denial analytics platforms and revenue cycle reporting tools.
• Proficiency with electronic health record 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.
• Preferred certifications: CPC, CCS, CRCR, or CHFP.
• Preferred experience: AI-assisted denial management platforms, complex clinical appeals such as medical necessity, experimental or investigational determinations, and presenting denial management performance to revenue cycle leadership.

• Location: Remote.
• Employment type: hourly.

• Pay rate: 70 - 93 hourly.

• Fluent English required for evaluating and documenting appeal quality and providing feedback.
• Ability to access and work with EHR and billing systems as required by the role.