Senior Analyst, Denial Management

At Commure our mission is to simplify healthcare We have bold ambitions to reimagine the healthcare experience setting a new standard for how care is delivered and experienced across the industry Our growing suite of AI solutions spans ambient AI clinical documentation provider copilots autonomous coding revenue cycle management and more - all designed for providers administrators to focus on what matters most providing care Healthcare is a 4 5 trillion industry with more than 500 billion spent annually on administrative costs and Commure is at the heart of transforming it We power over 500 000 clinicians across hundreds of care sites nationwide - more than 10 billion flows through our systems and we support over 100 million patient interactions With new product launches on the horizon expansion into additional care segments and a bold vision to tackle healthcare s most pressing challenges our ambition is to move from upstart innovator to the industry standard over the next few years Commure was recently named to and is backed by world-class investors including General Catalyst Sequoia Y Combinator Lux Human Capital 8VC Greenoaks Capital Elad Gil and more Commure has achieved over 300 year-over-year growth for the past two years and this is only the beginning Healthcare s moment for AI-powered transformation is here and we re building the technology to power it Come join us in shaping the future of healthcare About the Role We re seeking a Denials Team Lead with hands-on experience across both inpatient and outpatient denials to drive overturns reduce aged inventory and prevent recurrence at the root cause You ll lead a pod of denial analysts set daily priorities coach for quality and speed and collaborate with Coding Charge Entry Registration and Payer Relations to improve first-pass yield and cash acceleration Key Responsibilities Team Leadership Delivery Lead a team of denial analysts across IP OP workqueues plan capacity assign work and monitor performance Run daily huddles set targets for productivity quality and TAT remove blockers and manage escalations Conduct 1 1s coaching cross-training and performance reviews Denials Resolution Review EOB ERA CARC RARC codes payer policies and medical necessity criteria to build strong appeals Oversee timely filing resubmissions corrected claims and second-level medical appeals Drive overturns on common IP denials e g level of care lack of medical necessity DRG changes and OP denials e g bundling NCCI edits MUEs modifiers prior auth Quality Analytics Prevention Own team KPIs denial-to-resolution TAT aged bucket reduction 90 120 first-pass acceptance and QA Perform root-cause analysis by payer denial reason service line partner with Coding to fix upstream leakage Maintain SOPs and payer playbooks run calibration with QA Compliance Documentation Ensure HIPAA compliance accurate account notes and audit-ready documentation Track and meet payer-specific TATs and timely filing limits Commure Athelas is committed to creating and fostering a diverse team We are open to all backgrounds and levels of experience and believe that great people can always find a place We are committed to providing reasonable accommodations to all applicants throughout the application process Please be aware that all official communication from us will come exclusively from email addresses ending in or Any emails from other domains are not affiliated with our organization Employees will act in accordance with the organization s information security policies to include but not limited to protecting assets from unauthorized access disclosure modification destruction or interference nor execute particular security processes or activities Employees will report to the information security office any confirmed or potential events or other risks to the organization Employees will be required to attest to these requirements upon hire and on an annual basis