Appeals Manager - Fully Remote | Upto $93/hr
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 , Peter Thiel , Adam D'Angelo , Larry Summers , and Jack Dorsey .
Position: Denials Management & Appeals Manager
Type: Contract
Compensation: $93/hour
Location: Remote
Role Responsibilities
- Lead denials management and appeals operations. Oversee the 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 .
Qualifications
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.
Application Process (Takes 20–30 mins to complete)
- Upload resume
- AI interview based on your resume
- Submit form
Resources & Support
- For details about the interview process and platform information, please check:
- For any help or support, reach out to:
PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.
Originally posted on Himalayas