Manager, Appeals Management

This is a fully remote position, open to applicants in United States.

📋 Description

• The Manager of Clinician Appeals is tasked with the strategic management and operational implementation of appeals letter writing and client education initiatives.

• Lead high-achieving clinical teams in crafting clinically precise, convincing, and compliant appeal communications directed at payers.

• Ensure operational excellence, uphold clinical integrity, and align with financial objectives.

• Collaborate closely with internal leadership, administrative operations, and external clients to guarantee top-tier service delivery in a dynamic revenue cycle setting.

• Build, manage, and expand the clinical letter writing team, ensuring appropriate staffing levels are maintained.

• Complete training programs and set quality assurance standards for the team.

• Develop and consistently enhance comprehensive quality assurance programs.

⛳️ Requirements

• RN license is required; an active, unrestricted medical license (in any state) is preferred.

• A minimum of 8+ years of clinical experience, including at least 5 years in a leadership position within appeals, utilization management, clinical documentation improvement (CDI), or related revenue cycle management functions.

• Experience with DRG Downgrade is essential.

• Strong understanding of payer appeals processes, healthcare regulations, and documentation standards.

• Proven success in managing clinical teams in a high-volume, fast-paced environment.

• Demonstrated experience in developing quality assurance programs and executing clinical workflow enhancements.

• Strong comprehension of financial models and operational key performance indicators in the revenue cycle sector.

• Exceptional communication, collaboration, and leadership abilities.

🏝️ Benefits

• Medical/Dental/Vision Insurance

• Equipment provided

• 401k matching program

• FTO: Flex Unlimited Annual PTO

• Paid Paternity & Maternity leave programs

• 9 paid annual holidays

• Life Insurance

• Long term disability

• Short term disability options

• Tuition reimbursement and much more!