Revenue Cycle Denials & Appeals Lead

Exagen Inc.

Carlsbad (CA)

Hybrid

USD 75,000 - 95,000

Full time

14 days+

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Benefits offered by this job

Medical, dental, and vision insurance

Health Care and Dependent Care FSA

401(k) retirement savings program

4 weeks PTO

Paid company holidays

Employer-paid life insurance

Short-term and long-term disability

Job summary

Exagen Inc. in Carlsbad, CA is seeking a Reimbursement & Appeals Supervisor to lead denial and appeal workflows across commercial and government payers. This hybrid role requires on-site presence Monday, Wednesday, and Thursday, with commuting-friendly location in Carlsbad.

The ideal candidate will have 5+ years in healthcare revenue cycle with back-end denial experience, strong data analysis skills, and a proven ability to drive corrective actions and process improvements within a dynamic team.

Qualifications

2+ years of direct supervisory or formal team leadership experience in a healthcare business office, revenue cycle, laboratory, hospital, physician, or similar payer-facing environment.
Five (5) or more years of progressive healthcare revenue cycle experience with substantial hands-on responsibility for back-end denials, appeals, payer follow-up, reimbursement, or revenue recovery.
Demonstrated experience managing multiple denial categories and appeal levels across commercial and government payers.

Responsibilities

Oversee daily denial, appeal, payer follow-up, and reimbursement recovery activities, ensuring work is prioritized by filing deadline, appeal level, balance, aging, payer requirements, and likelihood of recovery.
Direct the review and resolution of complex denials, including medical necessity, coding, bundling, modifier, timely filing, documentation, and reimbursement-related denials.
Ensure appeals are accurate, complete, persuasive, supported by applicable records and payer policy, and submitted within contractual or regulatory timeframes.
Guide escalation through payer-specific reconsideration, external review, administrative, regulatory, and other dispute pathways when appropriate.
Monitor appeal inventory, aging, overturn rates, recovered revenue, upheld denials, write-offs, and unresolved payer issues.
Review underpayments and reimbursement variances; coordinate corrective action and payer escalation when payments do not align with applicable terms, policies, or expected reimbursement.