Denials Management & Appeals Manager

aitrainer; Deutschland; Vor Ort; EUR 70.000 - 90.000; Vollzeit

Benefits dieser Stelle

Opportunity to work on high-impact AI projects

Collaboration with a leading AI research organisation

Zusammenfassung

Aitrainer is seeking an experienced Denials Management and Appeals Manager in Germany. This role focuses on evaluating AI tools for automation in denial prevention, appeal writing, and analysis of denial workflows. You will lead operations, ensuring compliance and efficiency in claim denials while monitoring key performance indicators.

The ideal candidate will have over 5 years of experience in revenue cycle operations, strong knowledge of denial codes, and the ability to coordinate with various teams to enhance denial management processes.

Qualifikationen

• 5+ years of experience in denials management, appeals, or revenue cycle operations.
• Deep knowledge of denial codes and payer denial patterns.
• Strong understanding of appeal processes including peer-to-peer reviews.
• Exceptional English communication skills.

Aufgaben

• Lead denials management and appeals operations.
• Evaluate AI-generated appeal letters for accuracy.
• Develop appeal strategies across multiple payer types.
• Monitor denial management KPIs.
• Ensure compliance with payer appeal requirements.

Kenntnisse

Experience in denials management

Knowledge of CARC/RARC denial codes

Clinical and technical appeals

Denial analytics platforms

EHR systems and billing platforms

Attention to detail

Communication skills

Ausbildung

CPC, CCS, CRCR, or CHFP certification

Jobbeschreibung

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.

We consider all qualified applicants without regard to legally protected characteristics and provide reasonable accommodations upon request.