Senior Technical Denials Specialist
About The Position
We are hiring a Senior Technical Denials Specialist to bring deep, hands-on expertise in non-clinical (technical/administrative) denials to our Product and Engineering teams. You will own the design and validation of the SmarterDenials Admin SKU and Platform triage logic — the high-volume, fast-resolution layer that handles 70-80% of all denials (claim errors, eligibility, timely filing, additional documentation, non-covered services, etc.). This is a high-impact individual-contributor / small-team-lead role that directly shapes how AI automates and prevents the most common denials across acute and ambulatory settings. This position reports directly to Dan Parsons, Director of Product Engineering, and works closely with senior leadership across Product, Engineering, Finance, and Operations.
Requirements
- 7–15+ years in healthcare Revenue Cycle Management (RCM).
- 4–7+ years specifically focused on technical/non-clinical denials management and prevention.
- Proven experience in both health-system/hospital (UB-04 facility claims) and ambulatory/physician-practice/ASC (CMS-1500 professional billing) environments.
- Demonstrated success reducing technical denial rates by 20–40%+ through process, rules, or technology initiatives.
- Expert working knowledge of clearinghouses (Waystar, Change Healthcare, Experian), EDI 837/835 transactions, claim scrubbers, denial resolution paths, and major payer portals.
- Strong analytical skills and ability to translate operational pain points into clear product/engineering requirements.
- HFMA CRCR (required); CPB, CSPPM/CSAPM, or AAHAM CRIP preferred.
Nice To Haves
- Experience at an RCM vendor, clearinghouse, high claim volume multi-state provider, or payer side (technical claims side).
- Familiarity with AI/ML applications in RCM or denial analytics tools.
- Lean/Six Sigma or process-improvement certification.
Responsibilities
- Serve as the authoritative SME on technical CARC/RARC codes, mapping, and workflows (CO-16, CO-29, CO-22, CO-96, PR-204, etc.).
- Define product requirements for auto-scrub, intelligent resubmission, documentation-request automation, and worklist prioritization for soft denials.
- Design root-cause prevention logic that feeds denial patterns upstream to SmarterPrebill, SmarterUM, and Patient Access.
- Validate AI triage, CARC auto-mapping, and resubmission accuracy using real-world claim data.
- Collaborate daily with engineers on features for the Admin SKU and Platform (predictive risk scoring, payer-rule engines, analytics dashboards).
- Contribute to pilot programs and customer implementations, translating operational realities into measurable ROI (denial-rate reduction, first-pass acceptance, write-off prevention).
Benefits
- Competitive base salary (range and leveling to be finalized based on experience and location)
- Direct impact on a product family that attacks a $250B+ industry problem
- Fully remote role within the United States
- Flexible time off
- Comprehensive health benefits, including medical, dental, and vision coverage
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
