Manager, Appeals Management

CorroHealth•FL-Remote, FL

6d•Remote

About The Position

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: The Manager of Clinician Appeals is a clinical leader responsible for the strategic oversight and operational execution of the appeals letter writing and client education engagement. This individual will lead high-performing clinical teams in the development of clinically accurate, persuasive, and compliant appeal communications to payers, while ensuring operational excellence, clinical integrity, and alignment with financial goals. This position works closely with internal leadership, administrative operations, and external clients to ensure best-in-class service delivery in a dynamic revenue cycle environment.

Requirements

RN, required; active, unrestricted medical license (any state) preferred.
Minimum 8+ years of clinical experience with at least 5 years in a leadership role within appeals, utilization management, clinical documentation improvement (CDI), or similar RCM functions.
DRG Downgrade experience is mandatory.
Strong knowledge of payer appeals processes, healthcare regulations, and documentation standards.
Demonstrated success in managing clinical teams in a high-volume, fast-paced environment.
Proven experience developing QA programs and implementing clinical workflow improvements.
Strong understanding of financial models and operational KPIs in the revenue cycle industry.
Exceptional communication, collaboration, and leadership skills.

Nice To Haves

Previous experience in a revenue cycle management or health tech company.
Knowledge of DRG coding, CDI best practices, and payer denial trends.
Experience working with both domestic and global teams.

Responsibilities

Build, lead, and scale the clinical letter writing team, ensuring appropriate staffing levels aligned to current and forecasted client demand.
Oversee hiring, onboarding, training, and performance management of clinical writers.
Define and implement the team’s leadership structure and workflows.
Enforce quality and productivity standards; take corrective action as needed to maintain high performance.
Lead the team responsible for clinical review and oversight of appeal content.
Finalize training programs and establish QA standards for Ensure appropriate staffing, leadership hierarchy, and performance accountability for Quality Assurance & Clinical Integrity.
Develop and continuously improve robust QA programs
Ensure appeal content meets or exceeds clinical accuracy, appropriateness, and grammatical standards.
Drive clinical consistency across all client deliverables.
Understand the appeals financial model and associated KPIs; align clinical operations to meet or exceed revenue and margin targets.
Partner with administrative operations leadership to ensure seamless movement of cases through the appeals workflow.
Maintain a proactive awareness of client demand changes and implementation timelines to ensure clinical team capacity aligns with needs.
Identify and champion process improvement and efficiency initiatives to increase clinical team productivity without compromising quality.
Participate in client meetings, Q&A sessions, and escalations to provide clinical insight and support resolution.
Serve as a clinical subject matter expert for internal and external stakeholders.