Denial & Appeal Specialist

Sprinter Health • Menlo Park, CA

1d • $21 - $27

About The Position

Sprinter Health is reimagining healthcare access by bringing it directly to patients' homes, addressing the issue of people skipping preventive or chronic care due to accessibility challenges. They aim to reduce avoidable costs by providing care where people are, especially those in need. The company has supported over 2 million patients across 22 states, completed more than 130,000 in-home visits, and maintained a high Net Promoter Score (NPS). Sprinter Health has raised over $125 million from investors like a16z, General Catalyst, GV, and Accel, and has a multi-year runway.

Requirements

• 3+ years of medical billing experience with a focus on denials and appeals.
• Hands-on experience with Medicaid managed care and Medicare Advantage payers.
• Proficiency in 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 fluency.
• Working knowledge of ICD-10-CM, CPT, and HCPCS Level II coding.
• Ability to identify coding errors as denial root causes without needing to escalate to a coder.

Nice To Haves

• Experience with leading billing platforms.
• CPC, CCA, or CCS credential preferred, or equivalent hands-on experience.
• Experience with home health, preventive care, or value-based care billing.
• Prior experience in a lean or startup RCM environment where you built process, not just followed it.

Responsibilities

• Manage and work denial buckets across multiple payer relationships, focusing on pattern-level resolution.
• Write and submit clinical and administrative appeals, escalating to peer-to-peer review when appropriate.
• Analyze 835 remittance files to identify denial reason codes and trace root causes to submission or coding errors.
• Identify coding-driven denial trends (e.g., diagnosis-procedure mismatches, missing modifiers, bundling issues) and flag upstream for correction.
• Collaborate daily with the RCM platform team, coordinating on shared work queues and maintaining clear ownership divisions.
• Build and maintain a denial tracking log with aging, resolution status, and pattern tagging.
• Surface denial trends to the RCM Manager with actionable recommendations on a weekly cadence.
• Work cross-functionally with the Revenue Cycle Specialist to address systemic pre-submission and rejection issues leading to denials.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed