Senior Director, Clinical Denials
EnableComp
full-time
Posted on:
Location Type: Remote
Location: Remote • Tennessee • 🇺🇸 United States
Visit company websiteJob Level
Senior
About the role
- Serve as the vendor’s lead clinical subject matter expert on clinical denials management and prevention.
- Partner with provider clients to design and implement best practices for denial prevention and appeal workflows.
- Conduct complex clinical case reviews for DRG validation, identifying and defending clinically appropriate DRG assignments.
- Develop and refine clinical appeal strategies and templates to improve success rates.
- Analyze denial trends across multiple clients and provide actionable insights to reduce recurring clinical denials.
- Collaborate with coding, Clinical Documentation Integrity (CDI), and client operations teams to ensure consistency in methodologies and documentation practices.
- Maintain deep familiarity with Centers for Medicare & Medicaid Services (CMS) regulations, payer guidelines, and medical necessity criteria.
Requirements
- Minimum of 5 years of experience in clinical denials management or revenue integrity, with strong emphasis on DRG assignment and appeal writing.
- Excellent written communication and clinical reasoning skills for crafting persuasive appeals and client documentation.
- Strong knowledge of MS-DRG and APR-DRG methodologies, including Severity of Illness (SOI) and Risk of Mortality (ROM) classifications.
- Proficiency with CMS rules, payer contracts, and medical necessity guidelines (InterQual, MCG).
- Registered Nurse (RN) with at least 10 years of acute care clinical experience (ICU, Medical-Surgical, or similar).
- Experience working with or supporting multiple hospital or health system clients in a vendor, consulting, or outsourced revenue cycle capacity.
- Regular and predictable attendance.
Benefits
- EnableComp is an Equal Opportunity Employer M/F/D/V.
- We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.
- We believe that investing in our employees is the key to our success.
- We are dedicated to providing our employees with the tools, resources, and support they need to thrive and grow their career here.
- Flexible work arrangements
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical denials managementDRG assignmentappeal writingMS-DRG methodologyAPR-DRG methodologySeverity of Illness (SOI)Risk of Mortality (ROM)clinical case reviewsclinical appeal strategiesmedical necessity guidelines
Soft skills
written communicationclinical reasoningcollaborationanalytical skillsactionable insights
Certifications
Registered Nurse (RN)