Denial & Appeal Specialist

About Sprinter Health

Sprinter Health reimagines healthcare by delivering it directly to patients' homes. The company addresses a significant issue: nearly 30% of U.S. patients skip preventive or chronic care due to accessibility barriers. Many turn to emergency rooms instead, driving over $300 billion in unnecessary costs annually. With support from investors including a16z, General Catalyst, GV, and Accel, Sprinter Health has served over 2 million patients across 22 states and completed over 130,000 in-home visits, achieving a Net Promoter Score (NPS) of 92.

THE ROLE

We are seeking an experienced Denial & Appeal Specialist to manage denial management end-to-end across our diverse payer portfolio. Reporting directly to the Revenue Cycle Manager, this role involves working closely with our clearinghouse and billing platform partners and internal stakeholders to resolve denial patterns, write and submit appeals, and drive improvements in denial rates.

What You'll Do

• Manage and work denial buckets across multiple payer relationships, focusing on pattern-level resolution, not just individual claims
• Write and submit clinical and administrative appeals; escalate to peer-to-peer review when necessary
• Analyze 835 remittance files to identify denial reason codes (CO-4, CO-97, CO-16, PR-96, etc.) and trace root causes back to submission or coding errors
• Identify coding-driven denial trends such as diagnosis-procedure mismatches, missing modifiers, and bundling issues, and flag these for correction upstream
• Collaborate daily with the RCM platform team, coordinating on shared work queues and maintaining clear division of ownership between internal and platform-managed responsibilities
• Build and maintain a denial tracking log with aging, resolution status, and pattern tagging
• Surface denial trends to the RCM Manager with actionable recommendations on a weekly basis
• Work cross-functionally with the Revenue Cycle Specialist to address systemic pre-submission and rejection issues feeding into denials

Required

• 3+ years of medical billing experience with a focus on denials and appeals
• Hands-on experience across Medicaid managed care and Medicare Advantage payers
• Proficiency reading and interpreting 835 remittance files and CARC/RARC codes
• CMS-1500 and/or UB-04 billing experience
• Strong written communication skills for composing appeals
• Clearinghouse and RCM platform fluency — experience with leading billing platforms a plus, not required
• Working knowledge of ICD-10-CM, CPT, and HCPCS Level II coding
• Ability to identify coding errors as denial root causes without needing to escalate to a coder
• CPC, CCA, or CCS credential preferred — or equivalent hands-on experience

Nice to Have

• Experience with home health, preventive care, or value-based care billing
• Prior experience in a lean or startup RCM environment where you built processes, not just followed them