Denial & Appeal Specialist

Denial & Appeal Specialist Sprinter Health - 3.5 Menlo Park, CA Job Details Full-time $21 - $27 an hour 19 hours ago Qualifications Appeals Medicare Case appeal in utilization management Medical explanation of benefits reviews Medicaid Insurance claims appeal handling Full Job Description

ABOUT SPRINTER HEALTH

At Sprinter Health, our mission is reimagining how people access care by bringing it directly to their homes. Nearly 30% of patients in the U.S. skip preventive or chronic care simply because they can't get to a doctor's office. For many, the ER becomes their first touchpoint with the healthcare system—driving over $300B in avoidable costs every year. By using the same technologies that power leading marketplace and last-mile platforms, we deliver care where people are, especially those who need it most. So far, we've supported more than 2 million patients across 22 states, completed 130,000+ in-home visits, and maintained a 92 NPS. Our team of clinicians, technologists, and operators have raised over $125M to date investors like a16z, General Catalyst, GV, and Accel and enjoy multi-year runway.

THE ROLE

We are looking for an experienced Denial & Appeal Specialist to own denial management end-to-end across a complex, multi-payer book of business. You will work directly with our clearinghouse and billing platform partner and internal stakeholders to identify denial patterns, build appeals, and drive measurable improvement in denial rates from day one. This is a high-impact, high-ownership role on a lean team where your work will be directly visible in our revenue outcomes.

WHAT YOU'LL DO

Manage and work denial buckets across multiple payer relationships — pattern-level resolution, not just individual claims Write and submit clinical and administrative appeals; escalate to peer-to-peer review when appropriate Analyze 835 remittance files to identify denial reason codes (CO-4, CO-97, CO-16, PR-96, etc.) and trace root causes back to submission or coding errors Identify coding-driven denial trends — diagnosis-procedure mismatches, missing modifiers, bundling issues — and flag upstream for correction Collaborate daily with our RCM platform team, coordinating on shared work queues and maintaining clear division of ownership between internal and platform-managed responsibilities 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 close loop on systemic pre-submission and rejection issues feeding into denials

WHAT WE'RE LOOKING FOR

Required:

3+ years of medical billing experience with a focus on denials and appeals Hands-on experience across Medicaid managed care and Medicare Advantage payers Proficiency 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 — experience with leading billing platforms a plus, not required Coding Experience (Strongly Preferred): 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 CPC, CCA, or CCS credential preferred — or equivalent hands-on experience Nice to

Have:

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