مدير إدارة الرفض والاستئناف

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Denials Management and Appeals Managers to evaluate AI tools designed to automate denial prevention, appeal writing, and root cause analysis workflows. Your expertise in payer denial patterns, clinical and technical appeals, and denial management analytics will directly inform AI systems that reduce denial rates and maximise revenue recovery.

Responsibilities

• Lead denials management and appeals operations, overseeing the identification, categorisation, and resolution of claim denials.

• Evaluate AI-generated appeal letters, denial root cause analyses, and denial prevention recommendations for accuracy and effectiveness.

• Analyse 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.

• Manage the appeals calendar to ensure timely submission within payer and regulatory deadlines.

• Ensure compliance with payer appeal requirements, CMS regulations, and timely filing deadlines.

• Annotate AI outputs and provide structured feedback to support AI training datasets.

Requirements

• 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 Qualifications

• 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.

Why Join?

• Contribute to the development of frontier AI systems in healthcare.

• Collaborate with a world-class AI research organisation.

• Gain exposure to cutting-edge AI workflows in denials management and revenue cycle.

• Opportunity to work on high-impact projects shaping the future of healthcare AI.