Denial & Appeal Specialist

ABOUT SPRINTER HEALTH

At Sprinter Health our mission is reimagining how people access care by bringing it directly to their homes. Nearly 30% of patients in the U.S. skip preventive or chronic care simply because they can't get to a doctor's office. For many the ER becomes their first touchpoint with the healthcare system—driving over $300B in avoidable costs every year.

By using the same technologies that power leading marketplace and last-mile platforms we deliver care where people are especially those who need it most. So far we've supported more than 2 million patients across 22 states completed 130000+ in-home visits and maintained a 92 NPS. Our team of clinicians technologists and operators have raised over $125M to date investors like a16z General Catalyst GV and Accel and enjoy multi-year runway.

THE ROLE

We are looking for an experienced Denial & Appeal Specialist to own denial management end-to-end across a complex multi-payer book of business. You will work directly with our clearinghouse and billing platform partner and internal stakeholders to identify denial patterns build appeals and drive measurable improvement in denial rates from day one. This is a high-impact high-ownership role on a lean team where your work will be directly visible in our revenue outcomes.

WHAT YOU'LL DO

• Manage and work denial buckets across multiple payer relationships — pattern-level resolution not just individual claims

• Write and submit clinical and administrative appeals; escalate to peer-to-peer review when appropriate

• Analyze 835 remittance files to identify denial reason codes (CO-4 CO-97 CO-16 PR-96 etc.) and trace root causes back to submission or coding errors

• Identify coding-driven denial trends — diagnosis-procedure mismatches missing modifiers bundling issues — and flag upstream for correction

• Collaborate daily with our RCM platform team coordinating on shared work queues and maintaining clear division of ownership between internal and platform-managed responsibilities

• Build and maintain a denial tracking log with aging resolution status and pattern tagging

• Surface denial trends to the RCM Manager with actionable recommendations on a weekly cadence

• Work cross-functionally with the Revenue Cycle Specialist to close loop on systemic pre-submission and rejection issues feeding into denials

WHAT WE'RE LOOKING FOR

Required:

• 3+ years of medical billing experience with a focus on denials and appeals

• Hands-on experience across Medicaid managed care and Medicare Advantage payers

• Proficiency reading and interpreting 835 remittance files and CARC/RARC codes

• CMS-1500 and/or UB-04 billing experience

• Strong written communication skills for composing appeals

• Clearinghouse and RCM platform fluency — experience with leading billing platforms a plus not required

Coding Experience (Strongly Preferred):

• Working knowledge of ICD-10-CM CPT and HCPCS Level II coding

• Ability to identify coding errors as denial root causes without needing to escalate to a coder

• CPC CCA or CCS credential preferred — or equivalent hands-on experience

Nice to Have:

• Experience with home health preventive care or value-based care billing

• Prior experience in a lean or startup RCM environment where you built process not just followed it

What We Do

At Sprinter Health we're focused on dramatically expanding access to healthcare by reimagining the patient experience—delivered at home and powered by technology for scale. We’re a boots-on-the-ground clinician network for the tele-health age bringing routine blood draws labs and vitals checks into people's busy lives. We have completed over 140000 appointments in 2025 across the US!

Why Work With Us

Sprinter Health is reinventing access to care founded by the co-founder of Oculus in 2020. With tech AI and an incredible clinical team we bring preventive care into patients’ homes—reaching the vulnerable communities the healthcare system often misses. Join us in a supportive flexible family-friendly culture.

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