Sr. Director, Clinical Denials

Position Summary:

• Serve as the primary clinical authority supporting clients with denial prevention, appeal strategy, payer policy compliance, and industry education.
• Optimize revenue integrity, improve appeal outcomes, and reduce denial exposure.

Key Responsibilities:

• Partner with provider clients to design and implement best practices for denial prevention and appeal workflows.
• Represent EnableComp as an industry expert at national and regional conferences, networking opportunities, community outreach events, and client meetings.
• Lead client education sessions and internal training programs on Medicare Severity Diagnosis Related Group (MS-DRG) and All Patient Refined Diagnosis Related Group (APR-DRG) validation, clinical documentation integrity, and payer policy application.

Requirements and Qualifications:

• Minimum of 5 years of experience in clinical denials management or revenue integrity, with strong emphasis on DRG assignment and appeal writing.
• Strong knowledge of MS-DRG and APR-DRG methodologies, including Severity of Illness (SOI) and Risk of Mortality (ROM) classifications.
• Familiarity with Electronic Health Record (EHR) systems such as Epic, Cerner, or Meditech, and denials management platforms.