Remote Clinical Appeals Specialist

Summary

Join SmarterDx as a Clinical Appeals Specialist and play a key role in the company's next product launch. This role will work closely with Product and Data science to refine and collaborate on strategies that assist customers in decreasing denials through appeals.

Requirements

• Medical degree (RN or MD)
• Clinical and/or Appeals background, with the ability to grow and contribute across multiple functions as the role evolves

Responsibilities

• Review and refine technology-generated Clinical Denial Appeal letters, ensuring they align with best practices and regulatory requirements
• Collaborate with cross-functional teams to develop and optimize clinical denial strategies, along with creating and defining standardized templates that scale, focusing on DRG-Downgrade and Medical Necessity appeals
• Oversee the quality control process, owning the integrity of appeal documentation and ensuring consistency across all team outputs
• Play a key role in evolving the clinical denial workflow by providing insights and recommendations that influence product development and improvements
• Potentially contribute to the product strategy and work closely with the technology team to enhance the appeal process

Benefits

• Medical/dental/vision benefits
• 401k
• Free One Medical membership
• Parental leave
• Remote first