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 (level of care, lack of medical necessity, DRG changes) and OP denials ( 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 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.(ref : iimjobs.com)