Role OverviewThe Denials Management Expert - AI Tools will lead denials management and appeals operations, evaluating AI-generated appeal letters and denial root cause analyses for accuracy and effectiveness. The role involves analyzing denial trends, developing appeal strategies, and ensuring compliance with payer appeal requirements and CMS regulations.
What You Will Do
The main responsibilities of this role include leading denials management and appeals operations, evaluating AI-generated appeal letters and denial root cause analyses, and developing and managing clinical and technical appeal strategies across multiple payer types.
Why It Might Be a Fit
This role requires a strong understanding of clinical and technical appeal processes, including peer-to-peer reviews and external reviews. The ideal candidate will have experience with denial analytics platforms and revenue cycle reporting tools, as well as proficiency with EHR systems and billing platforms.
Requirements
- 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/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 with 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 with the ability to evaluate appeal quality and identify errors in AI-generated denial management content.
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