Senior Appeals & Denials Resolution Manager (Fully Remote)

Big Health; United States; A distancia; USD 95.000 - 125.000; Jornada completa

Descripción de la vacante

Big Health is a remote-first company delivering FDA-cleared digital therapeutics for common mental health conditions. The role focuses on managing end-to-end appeals operations in the U.S., handling complex denials, and building data-driven strategies to improve approval rates.

You will collaborate with payer teams, ensure timely submissions, and escalate policy issues to Market Access leadership. As part of the team, you will help standardize appeals procedures, oversee AI-supported workflows,

Responsabilidades

• Manage end-to-end appeals operations from denial intake through resolution.
• Personally handle complex denials involving medical necessity, coding, and reimbursement.
• Build case-specific appeal strategies and ensure timely submissions.
• Communicate with payer teams to identify basis for denials.
• Distinguish benefit exclusions from administrative errors.
• Escalate systemic policy issues to Market Access leadership.
• Build standardized operating procedures for appeals workflows.
• Serve as operational owner for AI-supported appeals workflows.
• Identify workflow improvements while adhering to compliance requirements.
• Track appeal overturn rates and performance metrics.
• Provide regular reporting to leadership and cross-functional teams.
• Accountable for team readiness, training, and oversight of resources.

Descripción del empleo

• Manage end-to-end appeals operations from denial intake through resolution.
• Personally handle complex denials involving medical necessity, coding, and reimbursement.
• Build case-specific appeal strategies and ensure timely submissions.
• Communicate with payer teams to identify basis for denials.
• Distinguish benefit exclusions from administrative errors.
• Escalate systemic policy issues to Market Access leadership.

Operations & AI-Enabled Process:

• Build standardized operating procedures for appeals workflows.
• Serve as operational owner for AI-supported appeals workflows.
• Identify workflow improvements while adhering to compliance requirements.
• Track appeal overturn rates and performance metrics.
• Provide regular reporting to leadership and cross-functional teams.
• Accountable for team readiness, training, and oversight of resources.

Big Health provides fully digital, non-drug options for common mental health conditions through FDA-cleared digital therapeutics. They are a remote-first company with a diverse team committed to equity and innovation in mental health care.