Denials Management & Appeals Manager

$70–93/hr

50 people hired

RemoteGlobalTechnology5-8 YearsContractPosted Aug 13, 2026

About this role

You will support the evaluation and improvement of next-generation healthcare AI systems focused on denial prevention, appeals management, revenue recovery, and root cause analysis. The role combines hands-on denials and revenue cycle expertise with AI quality evaluation. You will review AI-generated appeal letters, denial analyses, and prevention recommendations, identify inaccuracies or compliance risks, and provide structured feedback that helps improve automated denial-management workflows across commercial, Medicare, and Medicaid payers.

Responsibilities

Denials management: Lead the identification, categorisation, investigation, and resolution of healthcare claim denials.
AI output evaluation: Review AI-generated appeal letters, denial root cause analyses, and denial-prevention recommendations for accuracy, completeness, and effectiveness.
Denial analytics: Analyse denial trends by payer, CARC/RARC codes, denial category, and root cause.
Appeals strategy: Develop and manage clinical and technical appeal strategies across commercial, Medicare, and Medicaid payers.
Cross-functional coordination: Collaborate with clinical, coding, billing, compliance, and revenue cycle teams on denial-prevention initiatives.
KPI monitoring: Track denial rates, appeal overturn rates, revenue recovery, days in A/R, and related performance indicators.
Appeals calendar management: Ensure appeals are submitted within payer requirements, regulatory deadlines, and timely-filing limits.
Compliance: Maintain alignment with CMS requirements, payer appeal policies, and applicable regulatory standards.
AI training support: Annotate AI-generated content and provide structured expert feedback for healthcare AI training datasets.

Qualifications

5+ years of professional experience in denials management, appeals, revenue cycle management, or related healthcare operations, including at least 2 years in a management or leadership role.
Deep understanding of CARC/RARC denial codes, payer denial patterns, and appeal strategies.
Strong experience working with commercial insurance, Medicare, and Medicaid payers.
Strong understanding of clinical and technical appeals, including peer-to-peer reviews and external review processes.
Experience with denial analytics platforms, revenue cycle reporting tools, EHR systems, and healthcare billing platforms.
Ability to analyse denial trends, identify systemic root causes, and implement prevention strategies.
Strong knowledge of payer requirements, CMS regulations, appeal deadlines, and timely filing rules.
Exceptional written and verbal English communication skills.
Excellent attention to detail with the ability to identify errors or weaknesses in AI-generated healthcare denial and appeal content.Healthcare Denials Appeals Manager