Sr. Director, Clinical Denials

Key Responsibilities:

• 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.
• Analyze denial trends across multiple clients and provide actionable insights to reduce recurring clinical denials.

Requirements and Qualifications:

• Registered Nurse (RN) with at least 10 years of acute care clinical experience (ICU, Medical-Surgical, or similar).
• 5+ years of experience in clinical denials management or revenue integrity, with strong emphasis on DRG assignment and appeal writing.
• Proficiency with CMS rules, payer contracts, and medical necessity guidelines

Special Considerations and Prerequisites:

• Practices and adheres to EnableComp’s Core Values, Vision and Mission.
• Willingness to learn, adapt, and model resilience in a dynamic, high-expectation environment.
• Experience working with or supporting multiple hospital or health system clients