Denials Management & Appeals Manager

About this role

Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Denials Management and Appeals Managers to evaluate AI tools designed to automate denial prevention, appeal writing, and root cause analysis workflows. Your expertise in payer denial patterns, clinical and technical appeals, and denial management analytics will directly inform AI systems that reduce denial rates and maximise revenue recovery. **Responsibilities** - Lead denials management and appeals operations, overseeing the identification, categorisation, and resolution of claim denials. - Evaluate AI-generated appeal letters, denial root cause analyses, and denial prevention recommendations for accuracy and effectiveness. - Analyse denial trends by payer, denial code (CARC/RARC), and denial category to identify systemic root causes. - Develop and manage clinical and technical appeal strategies across multiple payer types. - Coordinate with clinical, coding, billing, and compliance teams to implement denial prevention initiatives. - Monitor denial management KPIs including denial rates, appeal overturn rates, revenue recovery, and days in A/R. - Manage the appeals calendar to ensure timely submission within payer and regulatory deadlines. - Ensure compliance with payer appeal requirements, CMS regulations, and timely filing deadlines. - Annotate AI outputs and provide structured feedback to support AI training datasets. **Requirements** - 5+ years of experience in denials management, appeals, or revenue cycle operations, with at least 2 years in a management role. - Deep knowledge of CARC/RARC denial codes, payer denial patterns, and appeal strategies across commercial, Medicare, and Medicaid payers. - Strong understanding of clinical and technical appeal processes including peer-to-peer reviews and external reviews. - Experience with denial analytics platforms and re