Denials Specialist (Appeals & Revenue Cycle)

Job Description Insight Global is seeking a fully remote Denials Specialist to support a Healthcare AI client. This is a part-time opportunity working approximately 10-20 hours/week where candidates will leverage their denials and appeals expertise to evaluate and improve AI-driven denial resolution strategies. This role is highly analytical and requires a strong understanding of payer requirements, denial root causes, and effective appeal strategies across multiple payer types. Laptop and equipment will be provided.

Shift Times:

Flexible scheduling within Monday-Friday, 9am-8pm PST (can't work weekends) (must be available 10-20 hours/week from 9am-8pm PST // ideal for individuals seeking additional income)

Duration:

3-month contract (potential to extend)

Responsibilities:

• Review denied claims and evaluate AI-generated denial analysis and appeal recommendations
• Assess the quality, logic, and persuasiveness of AI-generated appeal strategies across various denial types (medical necessity, authorization, coding, technical, etc.)
• Identify discrepancies where AI recommendations diverge from effective real-world denial management practices
• Analyze and explain successful appeal strategies, including payer-specific nuances and documentation requirements
• Evaluate appealability and determine optimal approach based on denial type, payer guidelines, and supporting documentation
• Provide detailed reasoning behind appeal strategies to help improve AI decision-making models
• Identify patterns and trends across denials to highlight systemic issues impacting reimbursement
• Partner with product and GTM teams to critique presentations and provide subject matter expertise on denial workflows and payer behavior We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day.

We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.

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https://insightglobal.com/workforce-privacy-policy/. Skills and Requirements

• 3+ year of denials management and appeals experience within a hospital or healthcare system
• Strong understanding of payer contracts, denial types, and appeal workflows
• Familiarity with medical necessity guidelines and payer-specific requirements
• Experience reviewing denied claims and drafting or supporting appeals
• Ability to think critically and clearly explain reasoning behind appeal decisions
• CPC, CCS, or equivalent coding certification
• Experience handling coding-related denials (DRG validation, CPT/ICD-10 disputes)
• Familiarity with denials management platforms (nThrive, Recondo, MedeAnalytics, etc.)
• Experience working across multiple payer types (commercial, Medicare Advantage, Medicaid)
• Comfort working in a tech-enabled or AI-supported healthcare environment