Job Description
**Denials Specialist - Remote**
**Role and Responsibilities:**
Review denied claims and AI-generated denials recommendations and appeal strategies.
Assess the reasoning quality and persuasiveness of AI-generated appeals across denial types and payers.
Identify cases where AI recommendations diverge from effective denials practices and explain why.
Describe the reasoning patterns behind successful appeals to our product team to improve AI recommendations — including how to evaluate appealability, how different arguments work with different payers, how to structure medical necessity appeals vs. authorization appeals, and how to recognize patterns that point to systemic issues.
Critique presentations and provide subject matter expertise to our GTM team.
**Required Credentials:**
Minimum 1 year hospital denials/appeals experience.
Working knowledge of payer contracts, medical necessity criteria, and appeal pro...
**Role and Responsibilities:**
Review denied claims and AI-generated denials recommendations and appeal strategies.
Assess the reasoning quality and persuasiveness of AI-generated appeals across denial types and payers.
Identify cases where AI recommendations diverge from effective denials practices and explain why.
Describe the reasoning patterns behind successful appeals to our product team to improve AI recommendations — including how to evaluate appealability, how different arguments work with different payers, how to structure medical necessity appeals vs. authorization appeals, and how to recognize patterns that point to systemic issues.
Critique presentations and provide subject matter expertise to our GTM team.
**Required Credentials:**
Minimum 1 year hospital denials/appeals experience.
Working knowledge of payer contracts, medical necessity criteria, and appeal pro...