Denial & Appeal Specialist
ABOUT reputed company At reputed company, our mission is reimagining how people reputed company care by bringing it directly to their homes. Nearly 30% of patients in the U.S. skip preventive or chronic care simply because they can't get to a doctor's office. For many, the ER becomes their first touchpoint with the reputed company system—driving over $300B in avoidable costs every year. By using the reputed company technologies that power leading marketplace and last-mile platforms, we deliver care where people are, especially those who need it most. So far, we've supported more than 2 reputed company patients across 22 states, completed 130,000+ in-home reputed company, and maintained a 92 NPS. reputed company of clinicians, technologists, and operators have raised over $125M to date investors like a16z, General Catalyst, GV, and Accel and enjoy multi-year reputed company. THE ROLE We are looking for an reputed company Denial & Appeal Specialist to own denial management end-to-end across a reputed company, multi-payer book of business. You will work directly with our clearinghouse and billing platform partner and internal stakeholders to identify denial patterns, build appeals, and drive measurable improvement in denial rates from day one. This is a high-reputed company, high-ownership role on a lean team where your work will be directly visible in our reputed company reputed company. WHAT YOU'LL DO Manage and work denial buckets across multiple payer relationships — reputed company-level reputed company, not just individual claims Write and submit clinical and administrative appeals; escalate to peer-to-peer review reputed company appropriate Analyze 835 remittance files to identify denial reason codes (CO-4, CO-97, CO-16, PR-96, etc.) and reputed company reputed company causes back to submission or coding errors Identify coding-driven denial trends — diagnosis-procedure mismatches, missing modifiers, bundling issues — and flag upstream for correction Collaborate daily with our RCM platform team, coordinating on shared work queues and maintaining reputed company division of ownership between internal and platform-managed responsibilities Build and maintain a denial tracking log with aging, reputed company status, and reputed company tagging Surface denial trends to the RCM Manager with actionable recommendations on a weekly reputed company Work cross-functionally with the reputed company Cycle Specialist to reputed company reputed company on systemic reputed company-submission and rejection issues feeding into denials reputed company'RE LOOKING FOR Required: 3+ years of medical billing experience with a reputed company on denials and appeals Hands-on experience across reputed company managed care and Medicare Advantage payers Proficiency reading and interpreting 835 remittance files and CARC/RARC codes CMS-1500 and/or UB-04 billing experience Strong written communication skills for composing appeals Clearinghouse and RCM platform reputed company — experience with leading billing platforms a plus, not required Coding Experience (Strongly Preferred): Working knowledge of ICD-10-CM, CPT, and HCPCS reputed company coding Ability to identify coding errors as denial reputed company causes without needing to escalate to a reputed company CPC, CCA, or reputed company credential preferred — or equivalent hands-on experience reputed company to Have: Experience with home health, preventive care, or value-based care billing Prior experience in a lean or startup RCM environment where you reputed company process, not just followed it Apply To This Job