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Senior Appeals & Denials Resolution Manager

11 hours, 12 minutes ago
United States
Full-time
Senior
Sales Operations
Operations
Apply Now
Big Health

Big Health

Big Health provides safe and effective non-drug alternatives for mental health conditions like insomnia and anxiety. Their digital therapeutics, including Sleepio and Daylight app, offer personalized behavioral medicine programs designed by experts.

Health Care Providers & Services
201-500
Founded 2010
$54M raised
View All Jobs 4

Description

  • Manage end-to-end payer appeals and denial-resolution operations, from intake through final resolution.
  • Personally investigate and resolve complex medical necessity, investigational, noncovered-service, coding, and reimbursement denials.
  • Develop evidence-based appeal strategies using clinical records, research, payer policies, coding guidance, and appeal requirements.
  • Communicate with payer claims, provider relations, utilization management, medical policy, and clinical review teams to investigate and escalate cases.
  • Build scalable procedures for triage, appeal drafting, submission, follow-up, quality review, escalation, and case closure.
  • Maintain complete case documentation and manage deadlines, workload prioritization, capacity, quality controls, and provider communications.
  • Own AI-supported appeals workflows, review AI-generated materials for accuracy and compliance, and retain accountability for submissions and complex decisions.
  • Track appeal performance metrics, identify root causes and systemic payer issues, and report recommendations to Market Access leadership.
  • Partner with Clinical, Legal, Finance, and provider-facing teams to obtain documentation and improve access and reimbursement strategy.
  • Lead function readiness, training, performance standards, staffing recommendations, and oversight of resources as the team scales.

Requirements

  • Bachelor’s degree in healthcare administration, business, health sciences, or a related field, or equivalent professional experience.
  • 7+ years of progressive experience in healthcare reimbursement, revenue cycle, denial management, or payer appeals.
  • 3+ years of ownership of complex appeals and 0–2 years of management experience, including workflow leadership, performance management, or appeals-resource oversight.
  • Proven success overturning challenging commercial payer denials.
  • Working knowledge of commercial payer and Medicare appeals, medical policies, CPT/HCPCS coding, remittance advice, denial codes, and reimbursement methodologies.
  • Strong appeal writing, payer communication, escalation judgment, case documentation, analytical problem-solving, data analysis, and resource-management skills.
  • Experience designing workflows, handling substantial case volumes, and meeting payer-specific timelines with limited supervision.
  • Experience in behavioral health, digital health, medical devices, specialty healthcare, or emerging technologies (preferred).
  • Familiarity with newer HCPCS codes, FDA-cleared therapies, investigational policies, and independent external review (preferred).
  • Experience bringing outsourced appeals in-house, implementing AI-supported revenue-cycle software, mentoring appeals staff, or holding CPC, CPMA, or CRCR credentials (preferred).

Benefits

  • Remote-first role that can be based anywhere in the United States.

Interested in this position?

Apply directly on the company website

Apply Now

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