Clinical Appeals Specialist

Role

The Clinical Appeals Specialist will play an important role in SmarterDx’s next product launch in the Appeal Writing space. This role will work closely with Product and Data science to refine and and collaborate on strategies that will assist our customers in decreasing denials through appeals. This role will have a creative and clinical view of the product and assist in writing documentation that will help serve as best-in-class representation of appeal writing strategies.

SmarterDx builds clinical AI that empowers hospitals to achieve 100% chart accuracy for revenue integrity. Our solution helps hospitals tell the most accurate and complete story of the patient and the care that was delivered, which helps them recover millions in earned revenue and improve quality of care scores. Become a Smartian and help optimize the way the healthcare system works for everyone. Learn more at smarterdx.com/careers.

What You’ll Do

• 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.

What You Bring

• Strong background in clinical denial strategies, with hands-on experience in creating and refining appeal letters (including DRG-Downgrade and Medical Necessity).
• A solid understanding of the clinical denial landscape, with experience in leading teams and ensuring quality control in high-stakes environments.
• Previous experience, or a strong interest, in advising or consulting for healthcare technology companies, with a passion for leveraging technology to streamline clinical processes.

Must Haves

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

Nice To Haves

• Previous advising experience with technology companies
• Strong leadership abilities, particularly in managing RN/MD teams that review patient charts and draft clinical denial appeals.

Compensation

• $100-120k base salary for Registered Nurse (RN) candidates, $150-180k base salary for MD candidates with a valid and active medical license in the US, + equity