Denials Management & Appeals Manager | $93/hr Remote
Overview
Elion Health is partnering with a top-tier AI research lab to refine next-generation healthcare AI systems. We're looking for a Denials Management and Appeals Manager who will use their deep revenue cycle expertise to evaluate and improve AI tools that automate denial prevention and appeal writing. Your insights will directly shape systems designed to reduce denial rates and optimize revenue recovery.
What You'll Do9
- 1Oversee the entire denials management and appeals operation, including identifying, categorizing, and resolving claim denials.
- 2Assess AI-generated appeal letters, root cause analyses, and denial prevention recommendations for accuracy and practical effectiveness.
- 3Examine denial trends by payer, denial code (CARC/RARC), and category to pinpoint systemic issues and recurring patterns.
- 4Build and execute both clinical and technical appeal strategies tailored to various payer types (commercial, Medicare, Medicaid).
- 5Collaborate with clinical, coding, billing, and compliance teams to implement proactive denial prevention measures.
- 6Track key performance metrics such as denial rates, appeal overturn rates, revenue recovery, and days in A/R.
- 7Maintain a comprehensive appeals calendar to ensure all submissions meet payer and regulatory deadlines.
- 8Ensure every appeal complies with payer requirements, CMS regulations, and timely filing rules.
- 9Annotate AI outputs and deliver structured feedback to improve the training datasets for denial management AI.
Requirements7
- 1At least 5 years of hands-on experience in denials management, appeals, or revenue cycle operations, including 2+ years in a leadership or managerial capacity.
- 2Expert-level familiarity with CARC and RARC denial codes, payer denial patterns, and effective appeal strategies across commercial, Medicare, and Medicaid payers.
- 3Solid grasp of both clinical and technical appeal processes—including peer-to-peer reviews and external reviews.
- 4Proven experience using denial analytics platforms and revenue cycle reporting tools.
- 5Proficiency with EHR systems and billing platforms (e.g., Epic, Cerner, or similar).
- 6Exceptional written and verbal English communication skills, with the ability to clearly present complex denial data.
- 7Meticulous attention to detail, especially when evaluating the quality of AI-generated appeal content and identifying errors.
Who Should Apply
This role is ideal for a seasoned revenue cycle professional who thrives on digging into denial data and crafting winning appeal strategies. You're comfortable working with cutting-edge AI tools and eager to provide real-world feedback that shapes smarter healthcare automation. If you have a track record of reducing denial rates and improving revenue recovery, and you're excited to apply your expertise to train AI systems, we want to hear from you.
Salary Insight
The role offers $93.00/hr on an hourly engagement basis.
Application Tip
When applying, highlight a specific example where you turned around a high-volume denial trend by analyzing CARC/RARC patterns and implementing a new appeal workflow—this shows you can bring the analytical depth needed to evaluate AI outputs.
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