Senior Appeals & Denials Resolution Manager

Appeals Management & Denial Resolution:

• Manage end-to-end appeals operations from denial intake through resolution.
• Personally handle complex denials involving medical necessity, coding, and reimbursement.
• Build case-specific appeal strategies and ensure timely submissions.

Payer Investigation & Escalation:

• Communicate with payer teams to identify basis for denials.
• Distinguish benefit exclusions from administrative errors.
• Escalate systemic policy issues to Market Access leadership.

Operations & AI-Enabled Process:

• Build standardized operating procedures for appeals workflows.
• Serve as operational owner for AI-supported appeals workflows.
• Identify workflow improvements while adhering to compliance requirements.

Performance, Reporting & Leadership:

• Track appeal overturn rates and performance metrics.
• Provide regular reporting to leadership and cross-functional teams.
• Accountable for team readiness, training, and oversight of resources.