Team Lead, 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 Fortune’s Future 50 list for 2025 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.

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.