The Appeals Compliance Manager is responsible for drafting, reviewing, and enhancing appeal narratives submitted in response to insurance carrier denials. Leveraging legal training and a deep understanding of carrier guidelines, this role ensures that appeal responses are persuasive, accurate, and compliant. The Appeals Compliance Manager collaborates closely with attorneys and the Appeals Operations Manager but operates as an individual contributor focused solely on appeal content quality.
The following set of success factors describe the characteristics of those who are successful in our Firm:
- Helpful, Congenial, Personable, Positive
- Unpretentious, Approachable, Respectful, Team Oriented
- Accountable, Takes Ownership, Corrects Mistakes
- Organized, Timely, Confidential, Responsive (within 24 hours)
Duties and Responsibilities:- Review and rewrite attorney-provided narratives for clarity, legal accuracy, and strategic appeal
- Ensure appeal content aligns with specific carrier guidelines and expectations
- Collaborate with attorneys and legal assistants to gather essential case details
- Draft compelling, customized responses for high-impact or complex appeals
- Stay current on emerging denial trends to adjust narrative strategies accordingly
- Develop and maintain a library of sample appeal language and templates for recurring denial types
- Support quality control and compliance standards for all written appeal content
- Provide guidance on appeal verbiage, tone, and formatting to ensure consistency and professionalism
- Other duties as required
Education, Experience, and Skills:- Juris Doctorate (JD) required
- 2+ years of experience with insurance denials, appeals, or similar legal writing
- Exceptional writing and editing skills with high attention to detail
- Ability to translate legal and clinical data into persuasive narratives
- Strong organizational skills and ability to meet deadlines
- Experience working within a legal or revenue cycle environment preferred
- Proficient with Microsoft Office Suite and familiarity with eBilling platforms (e.g., LegalX, T360)
- Ability to work independently
What we offer you- Competitive compensation
- Comprehensive benefits package, including medical, dental, and vision
- HSA and FSA plans available for employees and dependents
- Work-life balance
- Generous PTO policy
- 401K plan including a 3% Employer Safe Harbor contribution
- Firm paid life insurance and long-term disability
- Employee Assistance Program
- Year-end bonuses and referral fee programs
