San Francisco, CA · Remote
$21.25 - $28.25/hr
Denials Specialist - Remote Role and Responsibilities: Review denied claims and AI-generated ... Experience with at least one denials management platform preferred (e.g., nThrive, Recondo ...
San Francisco, CA · Remote
$21.25 - $28.25/hr
Denials Specialist - Remote Role and Responsibilities: Review denied claims and AI-generated ... Experience with at least one denials management platform preferred (e.g., nThrive, Recondo ...
| Aspect | Remote Nthrive Nthrive | Remote Nthrive Nthrive |
|---|---|---|
| Credentials | Typically requires industry-specific certifications | Same as Remote Nthrive Nthrive |
| Work Environment | Remote, collaborative online setting | Same as Remote Nthrive Nthrive |
| Industry Usage | Commonly used in healthcare and tech sectors | Same as Remote Nthrive Nthrive |
| Search Intent | Often compared for remote healthcare or tech roles | Same as Remote Nthrive Nthrive |
Both roles are similar in credentials, work environment, and industry usage, primarily serving remote positions in healthcare or tech sectors. The main difference lies in specific job functions or employer branding, but generally, they are interchangeable in search and comparison contexts.
$21.25 - $28.25/hr
Part-time
Medical, Dental, Vision, Life, Retirement
Posted 7 days ago
Denials Specialist - Remote
Role and Responsibilities:
Review denied claims and AI-generated denials recommendations and appeal strategies.
Assess the reasoning quality and persuasiveness of AI-generated appeals across denial types and payers.
Identify cases where AI recommendations diverge from effective denials practices and explain why.
Describe the reasoning patterns behind successful appeals to our product team to improve AI recommendations — including how to evaluate appealability, how different arguments work with different payers, how to structure medical necessity appeals vs. authorization appeals, and how to recognize patterns that point to systemic issues.
Critique presentations and provide subject matter expertise to our GTM team.
Required Credentials:
Minimum 1 year hospital denials/appeals experience.
Working knowledge of payer contracts, medical necessity criteria, and appeal procedural requirements.
Coding certification (CPC/CCS) required for coding-related denials.
Experience with at least one denials management platform preferred (e.g., nThrive, Recondo, MedeAnalytics).
"Pursuant to the San Francisco Fair Chance Initiative, Amergis will consider for employment qualified applicants with arrest and conviction records"
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