Sr. Director, Clinical Denials

📋 Description

• Lead clinical SME on denials management and prevention.
• Partner with provider clients to design denial prevention workflows.
• Conduct DRG validation reviews and defend assignments.
• Develop clinical appeal strategies to improve success rates.
• Analyze denial trends to reduce recurring denials.
• Represent EnableComp as a clinical expert in client meetings and escalations.

🎯 Requirements

• Bachelor's Degree.
• RN with 10+ years acute care clinical experience (ICU, Medical-Surgical, or similar).
• 5+ years in clinical denials management or revenue integrity with DRG emphasis.
• Excellent written communication and clinical reasoning for persuasive appeals.
• Strong knowledge of MS-DRG and APR-DRG methodologies, including SOI and ROM classifications.
• Proficiency with CMS rules, payer contracts, and medical necessity guidelines (InterQual, MCG).

🎁 Benefits

• EnableComp is an Equal Opportunity Employer M/F/D/V.
• EnableComp recruits, develops and retains the industry's top talent.