Senior Denials & Appeals Strategist (RCM)

Jobtailor; Burlington (NC); On-site; USD 90,000 - 130,000; Full time

Job summary

Jobtailor in Burlington, NC seeks an experienced revenue cycle professional to lead high-value payer appeals. You will analyze denial patterns, develop scalable strategies, and draft exemplar appeals across commercial and government payers.

Responsibilities include partnering with operations, mining large datasets, and translating insights into enterprise-wide reimbursement opportunities. Strong Excel, policy interpretation, and coding knowledge are essential.

Qualifications

• Bachelor’s degree or higher in a related field with 7+ years in healthcare revenue cycle, reimbursement, or denial management
• 7+ years of experience in healthcare revenue cycle, reimbursement, or denial management
• 5+ years of hands-on experience analyzing healthcare datasets, including claims, denials, and remittance data
• Advanced proficiency in Microsoft Excel, including large dataset manipulation and data analysis
• Direct experience managing appeals and denials across commercial and/or government payers, including tracking outcomes and driving resolution strategies
• Demonstrated experience drafting appeal letters with supporting clinical and policy rationale
• Strong knowledge of medical terminology and healthcare billing/coding concepts
• Proven ability to interpret payer policy language and translate policy criteria into actionable appeal strategies or reimbursement opportunities
• Experience with laboratory billing, diagnostics, or molecular/genetic testing
• Certifications such as RN, LPN, MT/MLS, CPC, CCS
• Experience with policy research or reimbursement optimization
• Advanced Excel (required)
• SQL or similar data query tools (preferred)
• Data visualization tools (Tableau, Power BI) (preferred)
• Analytical tools (SAS) (preferred)

Responsibilities

• Identify and prioritize high-value, scalable appeal opportunities across commercial and government payers
• Develop and standardize appeal strategies and frameworks based on payer policy, denial trends, and financial impact
• Draft complex or exemplar appeals to establish best practices and reusable templates
• Partner with operational teams to enable execution of appeals at scale, rather than performing routine claim-level submissions
• Analyze large healthcare datasets (claims, remittance, denial, and clinical data) to identify trends, root causes, and recovery opportunities
• Design and execute advanced data mining techniques to surface actionable insights and quantify financial impact
• Translate data insights into enterprise-level appeal strategies and recovery initiatives, not individual claim resolution
• Interpret payer policies, LCD/NCDs, and medical necessity criteria to assess appeal viability
• Apply knowledge of billing guidelines, coding (CPT/HCPCS), and reimbursement methodologies
• Identify policy misalignment and develop targeted appeal strategies or escalation approaches
• Partner with Revenue Cycle, Denial Operations, and Payor Solutions teams to address systemic denial issues
• Provide subject matter expertise and guidance on appeal strategy and policy interpretation
• Support process improvement initiatives aimed at reducing denials and optimizing reimbursement

Skills

Revenue Cycle

Denial Management

Data Analysis

Excel

CPT/HCPCS Coding

Payer Policy

Policy Research

SQL

Tableau

Power BI

SAS

Laboratory Billing

Clinical/Coding Credentials

Education

RN

LPN

MT/MLS

CPC

CCS

Tools

Tableau

Power BI

SQL

SAS

Job description

Jobtailor in Burlington, NC seeks an experienced revenue cycle professional to lead high-value payer appeals. You will analyze denial patterns, develop scalable strategies, and draft exemplar appeals across commercial and government payers.

Responsibilities include partnering with operations, mining large datasets, and translating insights into enterprise-wide reimbursement opportunities. Strong Excel, policy interpretation, and coding knowledge are essential.