25 Sep
AmeriHealth Services
India
Position: AI Solutions Specialist – Denial Management Automation
Location: Remote
Employment Type: Full-Time / Contract
About the Role
We are seeking an experienced AI/RCM Solutions Specialist to design and implement a GPT-powered denial resolution assistant for our Denial Management team. The ideal candidate will have hands-on expertise in customizing and training large language models (like ChatGPT), combined with deep knowledge of healthcare revenue cycle management (RCM) — specifically denial management, payer policies, and claims workflows.
Your primary mission will be to build a scalable AI-driven solution that helps our denial specialists resolve claims faster, with higher accuracy,
and greater consistency across multiple third-party billing systems.
Key Responsibilities
- AI Development & Customization
- Build and fine-tune GPT models (via OpenAI API, embeddings, or fine-tuning) to understand denial codes, payer guidelines, and specialty-specific rules.
- Develop Custom GPTs or RAG (Retrieval-Augmented Generation) pipelines that integrate with denial management workflows.
- Implement structured prompts and system instructions for consistent outputs (appeal drafts, work notes, resolution steps).
- Data & Knowledge Base Integration
- Structure and normalize denial and paid claims data from multiple billing systems.
- Create a knowledge base (database, embeddings store, or external retrieval system) so GPT can compare denied claims against paid claim history.
- Ensure state-specific and payer-specific guidelines are integrated into the model.
- Workflow Automation
- Design user-friendly workflows for denial specialists (manual, semi-automated, or integrated with billing systems).
- Build tools to allow specialists to upload/export claim data (Excel/CSV) and receive AI-driven resolution suggestions.
- Ensure outputs are consistent with compliance, payer policy, and organizational SOPs.
- Collaboration & Training
- Work closely with denial specialists to understand pain points and translate them into automation opportunities.
- Train staff on using the GPT assistant effectively.
- Iterate and improve AI accuracy based on feedback.
- Compliance & Security
- Ensure all solutions comply with HIPAA and data privacy regulations.
- Implement safe handling of PHI/PII data.
Required Qualifications
- Strong experience with OpenAI GPT models (ChatGPT, API, fine-tuning, embeddings, Custom GPTs).
- Hands-on experience building AI-powered automation solutions (chatbots, assistants, or RCM-specific tools).
- Deep understanding of RCM processes, especially denial management, claim submission, and payer-specific rules.
- Proficiency with data handling tools (SQL, Python, or no-code AI integration platforms like Zapier/Make/Retool).
- Ability to design end-to-end workflows from claim data extraction → AI processing → resolution output.
- Knowledge of HIPAA compliance and secure handling of healthcare data.
Preferred Qualifications
- Prior experience in a healthcare billing/denial management setting.
- Experience integrating AI with EHR/RCM platforms (Epic, Cerner, NextGen, eClinicalWorks, etc.).
- Familiarity with RPA tools (UiPath, Automation Anywhere) for payer portal automations.
- Strong technical writing skills to create prompts, system instructions, and documentation.
Job Types: Full-time, Internship, Contractual / Temporary, Freelance
Contract length: 6 months
Pay: From ₹25,000.00 per month
Application Question(s):
- Have you ever fine-tuned or customized GPT models for a specific business domain? If yes, describe the project.
- What is the difference between fine-tuning and retrieval-augmented generation (RAG), and when would you use each?
- Have you worked with claim datasets (Excel, CSV, SQL) and built pipelines to feed structured data into AI models?
- Describe a past project where you built a chatbot or AI assistant that automated repetitive workflows.
Work Location: Remote
📌 AI Solutions Specialist
🏢 AmeriHealth Services
📍 India
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