Manager, Appeals & Denial Resolution

Lucid Diagnostics • Lake Forest, CA

3d • Hybrid

About The Position

Manager, Appeals & Denial Resolution: The Strategic Appeals Manager role is responsible for managing denials, designing, leading, and optimizing appeal process for multiple appeal levels with the goal to maximize reimbursement, reduce denials, and influence payer behavior. This role combines clinical knowledge, basic payer policy expertise, analytics, and cross-functional leadership to manage high-impact, complex, and precedent-setting appeals across all lines of business. This is an exciting opportunity to join a fast paced, results-oriented, innovating team working together to prevent cancer. This is a full-time position based in Lake Forest, CA . Hybrid or remote options might be considered for the right candidate. At Lucid Diagnostics, we believe early detection will make esophageal cancer a disease of the past. We're using next generation sequencing to fundamentally change the way esophageal precancer is detected. Our groundbreaking EsoGuard DNA test assesses genes from cells collected from the esophagus in a quick, non-invasive procedure. This gives clinicians the ability to detect disease before it progresses to cancer, all without the need for sedation. We're focused on making a difference in patient care and we are seeking ambitious team members who do the same. When you join Lucid Diagnostics, you become part of a diverse, inclusive, and mission-driven team. We’re committed to creating an environment where you can thrive both professionally and personally. Here’s what you can expect when you join our team: Comprehensive Benefits: Enjoy top-tier medical, dental, and vision coverage, with 98% of employee healthcare premiums paid by the company, plus company-paid basic life insurance, and short- and long-term disability coverage. Financial Wellness: Build your future with a company 401(k) match (with immediate vesting) and an Employee Stock Purchase Program (ESPP) that lets you share in our success. Rest, Recharge and Give Back: Paid vacation, sick days, 12 company holidays, and a dedicated volunteer day to give back to the causes that matter to you. Professional Growth: Take your career to the next level with ongoing learning opportunities, hands-on training, and clear pathways for advancement. Wellbeing Support: Access employee assistance programs, wellness initiatives, and gym reimbursement to help you feel your best inside and outside of work. A Winning Culture: Proudly recognized as one of GenomeWeb’s 2025 Best Places to Work , we celebrate collaboration, innovation, and shared purpose every day.

Requirements

• Bachelor’s degree in healthcare administration, Nursing, Health Information Management, or related field
• 5+ years of healthcare revenue cycle, appeals, or payer relations experience (preferably in diagnostic space)
• Demonstrated success leading complex medical necessity and policy-based appeals
• Strong knowledge of ICD-10-CM, CPT/HCPCS, CMS rules, and commercial payer policies
• Experience with payer specific medical guidelines and how to apply them in an appeal
• Experience working with physicians and clinical leadership
• Strategic thinking and payor knowledge
• Clinical and regulatory interpretation
• Strong analytical and problem-solving skills
• Effective verbal and written communication skills
• Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines
• Data-driven decision making
• Executive communication and influence
• Process improvement and change leadership

Nice To Haves

• Master’s preferred
• Experience with external reviews, ALJs, or arbitration (preferred)
• Familiarity with denial management systems and analytics tools (preferred)

Responsibilities

• Help identify payer trends and root causes of denials and translate findings into proactive solutions
• Analyze Payor denials and make suggestions on appeal strategy to address them
• Oversee complex and systemic appeals, including but not limited to medical necessity, coding, authorization, non-covered benefits, low pay, etc.
• Develop keep up to date appeal packages based on the denial reason, current clinical guidelines, legislations and specific payor policies for multiple appeal levels
• Ensure appeals align with ICD-10-CM, CPT/HCPCS, and payer-specific rules
• Interpret and apply applicable clinical guidelines, specific payer medical policies, LCDs/NCDs, CMS regulations, and contract language
• Coordinate policy-based and clinical-based appeal arguments, including peer-to-peer and external review submissions
• Collaborate with internal (Sales, Clinical Team, Market Access, etc.) and external stakeholders (ordering physicians, patients) to coordinate the collection of appropriate Medical Records and ensure that strong clinical documentation is available to support appeal submissions
• Track appeal success rates, turnaround times, and ROI
• Build and maintain appeal playbooks, templates, and decision trees by payer and appeal level
• Manage day-to-day appeal operations, including workflows, prioritization, and timelines
• Ensure appeals are submitted timely and meet regulatory and payer requirements.
• Set up timely follow up on submitted appeals
• Train revenue cycle, clinical, commercial and authorization teams on appeal best practices and payer nuances
• Provide ongoing education on denial trends and appeals success
• Influence upstream process improvements to prevent repeat denials
• Other duties as assigned

Benefits

• top-tier medical, dental, and vision coverage, with 98% of employee healthcare premiums paid by the company, plus company-paid basic life insurance, and short- and long-term disability coverage
• company 401(k) match (with immediate vesting) and an Employee Stock Purchase Program (ESPP) that lets you share in our success
• Paid vacation, sick days, 12 company holidays, and a dedicated volunteer day to give back to the causes that matter to you
• ongoing learning opportunities, hands-on training, and clear pathways for advancement
• employee assistance programs, wellness initiatives, and gym reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 51-100 employees