Senior Appeals Manager

Job Summary

Seeking an experienced Senior Appeals & Denials Resolution Manager, this full-time remote position will manage payer appeals and denial resolution operations, independently investigate complex denials, develop evidence-based appeals, and design scalable workflows using AI-enabled technology.

Key Responsibilities

• Manage end-to-end appeals operations from denial intake through resolution, ensuring timely execution and quality oversight
• Build case-specific appeal strategies and communicate directly with payer teams to investigate and escalate denials
• Develop standardized operating procedures and maintain complete case records to enhance operational efficiency

Required Qualifications

• Bachelor's degree in healthcare administration, business, health sciences, or related discipline, or equivalent professional experience
• 7+ years of experience in healthcare reimbursement, revenue cycle, denial management, or payer appeals, including 3+ years of complex-appeal ownership
• Proven track record of successfully overturning challenging commercial payer denials
• Strong knowledge of commercial payer and Medicare appeal processes, medical policies, and reimbursement methodologies
• Excellent appeal-writing skills and experience designing operational workflows