About

Project Scope & Deliverables We are a technology-driven RCM firm seeking an elite Denials Management Specialist to join our team. Your primary focus will be leveraging strong analytical skills and deep RCM expertise to move beyond manual appeals, focusing instead on root cause identification and systemic process optimization. You will be responsible for maximizing revenue recovery and accelerating cash flow across complex, multi-specialty US medical billing. Work Schedule Commitment: 40 hours per week, Full-Time Hours: 9:00 AM to 5:00 PM EST (Eastern Standard Time) Location: 100% Remote Your Mission: Master Complex Denials and Drive Optimization Your role is to ensure maximum recoupment by tackling high-value, complex denials and providing data-backed strategy to prevent them in the future. Complex Appeals Strategy: Own the end-to-end appeal process for high-value claims across commercial, Medicare, Medicaid, and EAPs. Data-Driven Root Cause Analysis: Utilize advanced RCM reports and metrics to identify critical payer/CPT denial trends, providing actionable insights to leadership and automation teams. Workflow Optimization: Collaborate with internal teams to streamline claim submission, real-time status checking, and documentation processes to reduce turnaround time and improve first-pass clean claim rates. Non-Negotiable Requirements (The Elite Filter) Candidates who apply must meet the following criteria: Experience (Specialized): Minimum 3-4 years of specialized and focused experience in Denials Management within US Medical Billing/RCM. Systems Fluency: Expertise in multiple PM/EHR systems (e.g., Epic, Cerner, eClinicalWorks, Allscripts). Analytical Skills: Proven ability to analyze denial codes, RCM reports (aging, recovery rates), and raw data to develop and execute effective appeal and prevention strategies. Communication: Excellent written and verbal communication skills in English, suitable for writing professional appeal letters and communicating complex data to stakeholders. Technology and AI Experience (A BIG PLUS!) While not mandatory, candidates who can demonstrate experience or a strong understanding of working in a technology-forward RCM environment will be highly prioritized: AI/RCM Technology Exposure: Experience working with RCM automation tools, predictive analytics, or AI-assisted platforms for denial prediction or claim scrubbing. Integration Familiarity: Experience using data visualization tools (like Power BI or Tableau) or integrating EHR systems with external payment intelligence platforms.