Denials Management Expert - Analytics

• Lead denials management and appeals operations. Oversee identification, categorization, and resolution of claim denials.
• Evaluate AI-generated appeal letters, denial root cause analyses, and denial prevention recommendations for accuracy and effectiveness.
• Analyze denial trends by payer, denial code (CARC/RARC), and denial category to identify systemic root causes.
• Develop and manage clinical and technical appeal strategies across multiple payer types.
• Coordinate with clinical, coding, billing, and compliance teams to implement denial prevention initiatives.
• Monitor denial management KPIs including denial rates, appeal overturn rates, revenue recovery, and days in A/R.
• Ensure compliance with payer appeal requirements, CMS regulations, and timely filing deadlines.
• Annotate AI outputs and provide structured feedback to support AI training datasets., PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.

Must-Have

• 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.

Preferred

• CPC, CCS, CRCR, or CHFP certification.
• Experience with AI-assisted denial management platforms (e.g., Waystar, Experian Health, Nthrive).
• Background in complex clinical appeals including medical necessity, experimental/investigational, and level of care denials.
• Familiarity with AI tools and comfort evaluating AI-generated appeal and denial content.
• Experience presenting denial management performance to revenue cycle leadership.

About the job Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst…

• 11 days ago, About the job Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst…
• 13 days ago