Senior Director, Denials Management

Healthrise

Senior Director, Denials Management providing strategic leadership over denial management and audit defense in healthcare. Collaborating with executive leadership to optimize financial performance through effective management of denials.

Posted 6/2/2026full-time🇺🇸 United StatesSeniorWebsite

Tech Stack

Tools & technologies

Oracle

About the role

Key responsibilities & impact

Provides enterprise-level strategic and operational leadership over the organization’s denial management and post-payment audit defense programs.
Drives towards measurable improvement in overturn rates, write-off reduction, and audit recoupment defense across all facilities and service lines.
Owns the end-to-end denial lifecycle: prevention strategy, appeal operations, payer relations, post-pay audit response, and the technology and analytics infrastructure supporting the program.
Partners directly with the VP of Revenue Cycle, CFO, CMO, and CNO to translate denial data into enterprise-wide corrective action and sustainable revenue protection.
Establish annual goals for denial overturn rate, appeal yield, write-off reduction, and audit recoupment defense; report performance to executive leadership monthly.
Directs the clinical appeals team handling medical necessity, level-of-care, length-of-stay, and DRG clinical validation denials.
Oversees preparation of evidence-based appeal letters citing InterQual, MCG, CMS NCD/LCD, and payer medical policy.
Manages the physician advisor program and peer-to-peer review workflow for concurrent and retrospective denials.
Leads the coding denial team responsible for DRG downgrades, HCC validation, MS-DRG/APR-DRG disputes, modifier denials, and code-edit rejections.
Ensures compliant rebuttal of coding-related findings from commercial payers, Medicare Advantage, RAC, MAC, and SIU audits.
Directs the response to all post-payment audits and manages ADR workflows, audit logs, and other responses within CMS deadlines.
Builds career ladders, productivity standards, and quality assurance programs for each function.

Requirements

What you’ll need

Bachelor’s degree in Nursing, Health Information Management, Healthcare Administration, Business, or related field.
Minimum 10 years of progressive healthcare revenue cycle experience, with at least 5 years in a senior leadership role over denials, appeals, or audit functions in a hospital, health system, or large physician group.
Demonstrated track record of measurable improvement in denial overturn rate, write-off reduction, and audit recoupment defense at an enterprise scale.
Deep working knowledge of CMS regulations (Conditions of Participation, NCD/LCD, IPPS/OPPS, Two-Midnight Rule), commercial payer policy, and the Medicare appeals process through ALJ.
Expert command of medical necessity criteria (InterQual and/or MCG), ICD-10-CM/PCS, CPT/HCPCS, MS-DRG and APR-DRG methodology, and HCC risk adjustment.
Experience leading large, multi-site teams (30+ FTEs) including remote staff and vendor partners.
Proficiency with major EHR/revenue cycle platforms (Epic, Cerner/Oracle Health, Meditech) and denial management tools.
Completion of regulatory/mandatory certifications as required.
Willingness and ability to travel to client or organizational sites as needed.

Benefits

Comp & perks

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Hard Skills & Tools

denial managementpost-payment audit defenseappeal operationspayer relationsclinical validationcoding denialICD-10-CMCPTHCC risk adjustmentaudit recoupment defense

Soft Skills

strategic leadershipoperational leadershipcommunicationcollaborationgoal settingperformance reportingteam leadershipproblem-solvinganalytical thinkingquality assurance

Certifications

Bachelor’s degreeregulatory certifications