申诉经理 - 全程远程 | 最高每小时93美元
Appeals Manager - Fully Remote | Upto $93/hr
关于职位
Mercor 将顶尖的创意和技术人才与领先的 AI 研究实验室相连接。公司总部位于旧金山，我们的投资方包括 Benchmark、General Catalyst、Peter Thiel、Adam D'Angelo、Larry Summers 和 Jack Dorsey。
职位：拒赔管理与申诉经理
类型：合同制
薪酬：70–93 美元/小时
地点：远程办公
岗位职责
- 领导拒赔管理和申诉运营工作。监督索赔拒赔的识别、分类和解决。
- 评估 AI 生成的申诉信、拒赔根本原因分析和拒赔预防建议的准确性和有效性。
- 按支付方、拒赔代码（CARC/RARC）和拒赔类别分析拒赔趋势，以识别系统性根本原因。
- 在多种支付方类型中制定并管理临床和技术申诉策略。
- 协调临床、编码、计费和合规团队，实施拒赔预防措施。
- 监控拒赔管理 KPI，包括拒赔率、申诉推翻率、收入追回和应收账款天数。
- 确保符合支付方申诉要求、CMS 规定和及时提交截止日期。
- 标注 AI 输出内容，并提供结构化反馈以支持 AI 训练数据集。
任职要求
必须具备
- 5 年以上拒赔管理、申诉或营收周期运营经验，其中至少 2 年在管理岗位。
- 对 CARC/RARC 拒赔代码、支付方拒赔模式以及商业、医保和医疗补助支付方的申诉策略有深入了解。
- 对临床和技术申诉流程有深刻理解，包括同行评审和外部评审。
- 有使用拒赔分析平台和营收周期报告工具的经验。
- 熟练使用 EHR 系统和计费平台。
- 出色的英文书面和口头沟通能力。
- 极高的细节关注度，能够评估申诉质量并识别 AI 生成的拒赔管理内容中的错误。
优先考虑
- 持有 CPC、CCS、CRCR 或 CHFP 资格认证。
- 有使用 AI 辅助的拒赔管理平台（例如 Waystar、Experian Health、Nthrive）的经验。
- 具备复杂临床申诉背景，包括医疗必要性、实验性/研究性以及护理等级拒赔。
- 熟悉 AI 工具并能评估 AI 生成的申诉和拒赔内容。
- 有向营收周期领导层汇报拒赔管理绩效的经验。
- 申请流程（耗时 20–30 分钟）
查看英文原文
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:$70–$93/hour
Location:Remote
Role Responsibilities
- 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.
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