Clinical Operations Appeals Specialist
Company: AOTI
Role summary
Clinical Operations Appeals Specialist is a role at AOTI in Oceanside, California, United States (remote). Posted 2026-08-18. Experience level: 2-5.
- Job title
- Clinical Operations Appeals Specialist
- Company
- AOTI
- Location
- Oceanside, California, United States
- Work arrangement
- remote
- Category
- Healthcare Support
- Experience level
- 2-5
- Date posted
- 2026-08-18
You’ll be a vital advocate for patients by navigating the appeals process to ensure they get the medical support they need. It is a fantastic opportunity to build a career in healthcare administration where your attention to detail directly impacts patient outcomes and successful claim resolutions.
Job description
About AOTI
Advanced Oxygen Therapy, Inc. (AOTI) is transforming the future of wound care through breakthrough technologies that improve the lives of patients with chronic non-healing and acute complex wounds.
At the heart of our mission is our patented, multimodality Topical Wound Oxygen (TWO2) therapy, the only device of its kind proven effective in both Randomized Controlled Trials (RCTs) and Real-World Evidence (RWE) studies. TWO2 has delivered exceptional clinical outcomes, including an 88% reduction in hospitalizations and a 71% reduction in amputations among patients with Diabetic Foot Ulcers (DFUs) over 12 months.
In addition to TWO2, we offer the NEXA™ NPWT System, an innovative, multi-week, multi-patient Negative Pressure Wound Therapy (NPWT) device designed to deliver the clinical benefits of traditional durable systems with the convenience and simplicity of disposable solutions. The NEXA System is portable, easy to operate, and cost-effective—making advanced wound care more accessible across diverse care settings, from hospitals to the home.
Backed by a world-class international leadership team and a robust global infrastructure, AOTI offers a unique opportunity to make a meaningful impact in healthcare.
If you're driven by purpose and want to be part of a company that’s transforming wound care, we’d love to hear from you.
Why We’re Hiring
As demand for our TWO2 therapy continues to grow, we are expanding our team to ensure we maintain the highest standards of patient care. We are looking for compassionate and motivated individuals to join us in delivering life-changing therapy to more patients across the country.
Position Summary
The Clinical Operations Appeals Specialist is a national reimbursement and clinical documentation specialist responsible for leading insurance appeal activities across the United States. This role serves as the clinical and reimbursement expert for denied claims, partnering closely with physicians, wound consultants, market access, revenue cycle, and operational teams to develop compelling, evidence-based appeals that improve patient access to TWO2 therapy.
Location: Remote
Employment Type: Full-Time (Remote)
Benefits
In addition to competitive pay, we offer a comprehensive benefits package that includes:
Full benefits with a company-sponsored stipend
401(k) with company match
Company-paid Basic Life, AD&D, Short-Term, and Long-Term Disability Insurance
11 Paid Holidays + 2 Floating Holidays
Paid Vacation and Sick Time
Paid Volunteer Time Off to give back to your community
Employee Referral Bonuses
Car allowance, fuel reimbursement, and corporate discounts
Key Responsibilities
• Serve as the national subject matter expert for all insurance denials and appeals strategy involving Commercial, Medicare, Medicaid, Managed Medicaid, Workers' Compensation, and other governmental payers.
• Independently assess complex denials and determine the most appropriate appeal strategy based on clinical evidence, payer policy, reimbursement guidelines, and patient-specific circumstances.
• Develop persuasive, evidence-based appeal packages including Letters of Medical Necessity, clinical summaries, supporting literature, payer-specific documentation, and physician recommendations.
• Exercise independent judgment in prioritizing national appeal inventory to maximize reimbursement success and patient access.
• Identify emerging payer trends and proactively develop strategies to decrease the number of denials and improve overturn rates.
• Perform comprehensive clinical reviews to evaluate the strength of medical necessity and identify opportunities to improve reimbursement outcomes.
• Independently determine documentation deficiencies and collaborate directly with physicians, wound consultants, and clinical staff to obtain clinically meaningful information.
• Recommend documentation enhancements that strengthen future authorizations and appeals while ensuring compliance with payer requirements.
• Evaluate complex patient histories, wound progression, comorbidities, and treatment response to support reimbursement decisions.
• Function as a strategic advisor to field sales team regarding reimbursement strategy and complex patient access issues.
• Provide ongoing education and consultation to regional leadership teams on payer trends, documentation best practices, appeal strategy, and reimbursement updates.
• Participate in leadership meetings to review market trends, identify barriers to access, and develop national solutions.
• Build collaborative relationships across departments to improve organizational effectiveness and patient outcomes.
• Lead continuous improvement initiatives designed to increase appeal success rates and reduce reimbursement delays.
• Develop standardized appeal templates, documentation tools, workflows, educational resources, and best practices.
• Recommend policy and workflow enhancements based on payer trends, denial analysis, and operational data.
• Support implementation of new reimbursement initiatives and organizational priorities.
• Develop and deliver educational programs for sales leadership, wound consultants, physicians, and internal operational teams.
• Serve as an internal resource for complex reimbursement questions and medical necessity interpretation.
• Coach field teams on documentation strategies that improve payer acceptance while maintaining compliance.
• Assist in development of national reimbursement training programs and educational materials.
• Independently determine appeal strategy based on payer requirements and clinical evidence.
• Recommend escalation pathways for complex reimbursement cases.
• Exercise discretion in evaluating medical necessity documentation and identifying opportunities for improvement.
• Prioritize national workload based on organization