Denials Management Manager | Remote

Key Responsibilities

• Oversee end-to-end denials management operations, including denial identification, categorization 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 CHFPP
• 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