Lucid Diagnostics · 23 hours ago
Manager, Appeals & Denial Resolution
Lake Forest, CA
Full-time
Hybrid
Mid, Senior Level
5+ years expLucid Diagnostics is dedicated to transforming esophageal cancer detection through innovative technology. The Strategic Appeals Manager will manage denials and optimize the appeal process to maximize reimbursement and influence payer behavior, requiring a blend of clinical knowledge and leadership skills.
BiotechnologyHealth CareHealth DiagnosticsTherapeutics
Responsibilities
Help identify payer trends and root causes of denials and translate findings into proactive solutions
Analyze Payor denials and make suggestions on appeal strategy to address them
Oversee complex and systemic appeals, including but not limited to medical necessity, coding, authorization, non-covered benefits, low pay, etc
Develop keep up to date appeal packages based on the denial reason, current clinical guidelines, legislations and specific payor policies for multiple appeal levels
Ensure appeals align with ICD-10-CM, CPT/HCPCS, and payer-specific rules
Interpret and apply applicable clinical guidelines, specific payer medical policies, LCDs/NCDs, CMS regulations, and contract language
Coordinate policy-based and clinical-based appeal arguments, including peer-to-peer and external review submissions
Collaborate with internal (Sales, Clinical Team, Market Access, etc.) and external stakeholders (ordering physicians, patients) to coordinate the collection of appropriate Medical Records and ensure that strong clinical documentation is available to support appeal submissions
Track appeal success rates, turnaround times, and ROI
Build and maintain appeal playbooks, templates, and decision trees by payer and appeal level
Manage day-to-day appeal operations, including workflows, prioritization, and timelines
Ensure appeals are submitted timely and meet regulatory and payer requirements. Set up timely follow up on submitted appeals
Train revenue cycle, clinical, commercial and authorization teams on appeal best practices and payer nuances
Provide ongoing education on denial trends and appeals success
Influence upstream process improvements to prevent repeat denials
Other duties as assigned
Qualification
Required
Bachelor's degree in healthcare administration, Nursing, Health Information Management, or related field (Master's preferred)
5+ years of healthcare revenue cycle, appeals, or payer relations experience (preferably in diagnostic space)
Demonstrated success leading complex medical necessity and policy-based appeals
Strong knowledge of ICD-10-CM, CPT/HCPCS, CMS rules, and commercial payer policies
Experience with payer specific medical guidelines and how to apply them in an appeal
Experience working with physicians and clinical leadership
Strategic thinking and payor knowledge
Clinical and regulatory interpretation
Strong analytical and problem-solving skills
Effective verbal and written communication skills
Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines
Data-driven decision making
Executive communication and influence
Process improvement and change leadership
Preferred
Experience with external reviews, ALJs, or arbitration
Familiarity with denial management systems and analytics tools
Benefits
Comprehensive Benefits: Enjoy top-tier medical, dental, and vision coverage, with 98% of employee healthcare premiums paid by the company, plus company-paid basic life insurance, and short- and long-term disability coverage.
Financial Wellness: Build your future with a company 401(k) match (with immediate vesting) and an Employee Stock Purchase Program (ESPP) that lets you share in our success.
Rest, Recharge and Give Back: Paid vacation, sick days, 12 company holidays, and a dedicated volunteer day to give back to the causes that matter to you.
Professional Growth: Take your career to the next level with ongoing learning opportunities, hands-on training, and clear pathways for advancement.
Wellbeing Support: Access employee assistance programs, wellness initiatives, and gym reimbursement to help you feel your best inside and outside of work.
A Winning Culture: Proudly recognized as one of GenomeWeb’s 2025 Best Places to Work, we celebrate collaboration, innovation, and shared purpose every day.
Company
Lucid Diagnostics
Lucid Diagnostics Inc. (Nasdaq: LUCD) is a commercial-stage, cancer prevention medical diagnostics company, and subsidiary of PAVmed Inc.
51-200 employees
Funding
Current Stage
Public CompanyTotal Funding
$102.38MKey Investors
National Institutes of Health
2025-09-10Post Ipo Equity· $26.9M
2025-03-04Post Ipo Equity· $15.3M
2025-02-27Grant· $8M
Leadership Team
Lishan Aklog
CEO
D
Danielle Scelfo
Senior Vice President, Market Access and Government Affairs
Recent News
2026-01-22
2025-11-20
Company data provided by crunchbase