Denials Management & Appeals Manager

$70–93/hrrate as listed

Review AI-generated appeal letters, denial root cause analyses, and prevention recommendations against how commercial, Medicare, and Medicaid payers actually adjudicate. Work is contract, remote, and asynchronous, with observed rates of $70–93/hr on Mercor.

Summary, eligibility guidance and screening preparation are prepared by Sidequest from the platform's posting. Check the source listing before applying.

What the work involves

A frontier AI lab is building systems that draft appeals, categorize denials, and surface root causes across the revenue cycle. Your job is to tell them where those systems are wrong — and why, in terms a model can learn from. Day to day that means reading AI-generated appeal letters and judging whether the clinical argument, the cited policy, and the supporting documentation would actually hold up with the named payer; checking whether a denial was correctly mapped to its CARC/RARC combination and denial category; and stress-testing prevention recommendations against the operational reality of front-end registration, authorization, and coding workflows.

Expect structured annotation more than prose writing. Tasks typically ask for a rating, a specific error label, and a short written rationale pointing to the exact sentence or code that fails. Some batches ask you to author a gold-standard appeal for a given denial scenario so the model has a reference. Others ask you to compare two model outputs and defend a preference. Vague feedback like "weak appeal" gets rejected; "cites LCD language that was retired in 2023 and omits the timely-filing date required for this Medicaid plan" is what gets used.

What the platform screens for

Verifiable operational depth. Mercor's AI interviewer will probe specifics: denial categories you personally worked, overturn rates you were accountable for, how you built an appeals calendar under varying payer deadlines.
Code-level fluency. Expect follow-ups on distinguishing CARC from RARC, common medical-necessity denial patterns, and where technical denials differ from clinical ones.
Evaluation judgment. Can you separate an appeal that is well-written from one that is likely to be overturned? These are different, and the screen tests whether you know it.
Written English under scrutiny. Your rationales are the product. Sloppy or generic writing disqualifies.

Logistics

Fully remote and asynchronous. Contributors commonly commit 10–20 hours per week, though some projects scale up during active labeling pushes. Work is contract-based via Mercor; pay is hourly at rates observed in the $70–93 range for this role, with the exact figure set at offer and not guaranteed. Certifications (CPC, CCS, CRCR, CHFP) and hands-on time with denial analytics platforms strengthen an application but don't substitute for management-level operating experience.

What they look for

5+ years in denials management, appeals, or revenue cycle operations, including 2+ years managing a team
Working fluency with CARC/RARC denial codes and payer-specific denial patterns across commercial, Medicare, and Medicaid
Clinical and technical appeal drafting, including medical necessity, level of care, and experimental/investigational denials
Familiarity with peer-to-peer and external review processes and payer/CMS appeal deadlines
Precise written English suitable for structured evaluation rationales
Experience with denial analytics, revenue cycle reporting, EHR, and billing platforms

Before you apply

Would you pass this screen?

Drawn from what this listing actually requires. Answered in your browser — nothing is sent to us, and we do not store your answers.

Do you have at least 5 years of professional experience in denials management, appeals, or revenue cycle operations?
Denials Management / Appeals Experience · required
Do you have at least 2 years of experience in a management or lead role (managing denials, appeals, or revenue cycle teams or functions)?
Management Experience · required
Are you knowledgeable in CARC and RARC denial codes and payer denial patterns across commercial, Medicare, and Medicaid payers?
CARC/RARC & Payer Knowledge · required
Do you hold at least one of the following: CPC, CCS, CRCR, or CHFP certification?
Relevant Certification · preferred
Do you have hands-on experience with EHR systems and billing platforms used in revenue cycle operations?
EHR & Billing Platform Proficiency · required
Do you have proficiency in written and verbal English sufficient for detailed appeal writing and communication with clinical and revenue cycle teams?
Fluency in English · required

0 of 6 answered

Included with this listing

Interview prep — 10 questions

Matched to what this platform's screening actually measures. Answer each out loud in 60–90 seconds: claim → concrete example → implication.

What it tests: Can the candidate articulate the financial and clinical logic behind denial triage, including payer-specific appeal success rates and cost-benefit analysis? Do they think beyond 'appeal everything'?
A strong answer: A strong answer names a concrete denial (e.g., medical necessity, coding error, timely filing) and explains the reasoning: appeal success rate for that payer, cost to appeal versus likely recovery, contractual terms, and any clinical documentation gaps. It shows systematic triage, not guesswork.
Where people lose it: Candidates who give generic answers ('we appealed denials') or focus only on volume processed rather than the judgment call itself—or who admit they don't track appeal ROI by payer or denial type.