[Hiring] Appeals Manager @Mercor

Role Description

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

• 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.

Requirements

• 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

• Upload resume
• AI interview based on your resume
• Submit form

Resources & Support

• For details about the interview process and platform information, please check: Interview Process
• For any help or support, reach out to: [email protected]