Denials Management and Appeals Manager for AI Evaluation

Lead denials prevention and appeals strategy and apply subject matter expertise to evaluate AI tools that generate appeal letters, perform root cause analyses, and recommend denial prevention actions. This role combines hands-on denials operations with quality review and annotation of AI outputs to reduce denial rates and maximize revenue recovery.

• Oversee denials management and appeals operations, from identification and categorisation of claim denials through resolution.
• Evaluate AI-generated appeal letters, root cause analyses, and denial prevention recommendations for accuracy, completeness, and effectiveness.
• Analyze denial trends by payer, denial code, including 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 stakeholders to implement denial prevention initiatives.
• Monitor denial management KPIs, including denial rates, appeal overturn rates, revenue recovery, and days in accounts receivable.
• Maintain and manage the appeals calendar to ensure timely submission within payer and regulatory deadlines.
• Ensure compliance with payer appeal requirements, CMS regulations, and timely filing deadlines.
• Annotate AI outputs and provide structured, actionable feedback to improve training datasets and model performance.

• Minimum 5 years of experience in denials management, appeals, or revenue cycle operations, including at least 2 years in a management role.
• Deep knowledge of CARC/RARC denial codes, payer denial patterns, and appeal strategies for 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 EHR systems and billing platforms.
• Exceptional written and verbal English communication skills.
• High attention to detail and the ability to evaluate appeal quality, spotting errors in AI-generated denial management content.

• Certifications such as CPC, CCS, CRCR, or CHFP.
• Experience with AI-assisted denial management platforms and familiarity evaluating AI-generated denial and appeal content.
• Background managing complex clinical appeals, including medical necessity, experimental or investigational services, and level of care disputes.
• Experience presenting denial management performance to revenue cycle leadership.

Remote role, paid on an hourly basis.

Pay range: $70 to $93 per hour.

Contribute to the development of next-generation AI systems in healthcare, collaborate with a leading AI research organization, and gain exposure to advanced workflows in denials management and revenue cycle operations.