Appeals Manager - Fully Remote | Upto $93/hr

Mercor; San Francisco (CA); Remote; USD 95,000 - 125,000; Full time

Benefits offered by this job

Contribute to frontier AI systems in healthcare

Collaborate with a world-class AI research organization

Gain exposure to cutting-edge AI workflows

Job summary

Obsidian is seeking experienced Denials Management and Appeals Managers in San Francisco, California. This role involves overseeing denials management operations, evaluating AI tools for accuracy, and developing strategies across multiple payer types.

The ideal candidate has over 5 years of experience in denials management, strong analytical skills, and deep knowledge of denial patterns. Join us to contribute to the advancement of AI systems in healthcare and work on impactful projects.

Qualifications

• 5+ years of experience in denials management or revenue cycle operations.
• Deep knowledge of CARC/RARC denial codes and payer denial patterns.
• Experience with denial analytics platforms and revenue cycle reporting.

Responsibilities

• Lead denials management and appeals operations.
• Evaluate AI-generated appeal letters for accuracy and effectiveness.
• Monitor denial management KPIs and manage the appeals calendar.

Skills

Denials management

Appeals strategies

Clinical review processes

Analytical skills

Communication

Education

CPC, CCS, CRCR, or CHFP certification

Tools

EHR systems

Revenue cycle reporting tools

Denial analytics platforms

Job description

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.