Director Denial Management and Prevention (RN)

Accountabilities

• Partner with senior clinical resource management and organizational leaders to identify denial mitigation opportunities and develop reimbursement improvement strategies.

• Oversee system-wide denial appeals operations, including the performance and accountability of external appeal vendors.

• Provide strategic direction and clinical oversight for hospital denial management, prevention, recovery, and appeal outcomes.

• Develop and implement sustainable operational improvements that support organizational financial and clinical objectives.

• Establish performance goals and objectives using industry best practices, internal benchmarks, and denial management trends.

• Develop and maintain analytics, reporting tools, and dashboards that standardize denial summaries and support system-wide decision-making.

• Lead denial mitigation initiatives and serve as a subject matter consultant to individual hospital entities regarding denial trends, root causes, and interventions.

• Partner with Acute Case Management teams to improve operational processes, provide education, and support denial reduction efforts.

• Collaborate with Managed Care teams to identify, summarize, and address payer-related opportunities and challenges.

• Work with Corporate Compliance and Rates and Reimbursement teams to ensure denial management operations and policies align with applicable governmental and state regulations.

• Manage business partner and vendor relationships, ensuring contractual obligations and performance expectations are consistently met.

• Support the optimization and effective use of technology to improve operational efficiency, denial prevention, and reimbursement performance.

• Communicate performance trends, opportunities, and recommendations effectively to leaders and stakeholders across the organization.

Requirements:

• Hold a Bachelor's degree in Nursing.

• Bring 5–7 years of revenue cycle experience, including direct experience with appeals and financial clearance.

• Have leadership experience within healthcare, with revenue cycle leadership experience strongly preferred.

• Maintain an active Registered Nurse (RN) state license and/or compact state licensure.

• Demonstrate strong knowledge of denial management, appeals, reimbursement processes, and healthcare revenue cycle operations.

• Possess strong analytical and problem-solving abilities, with a high level of accuracy and attention to detail.

• Demonstrate excellent interpersonal and team-building skills with the ability to develop productive relationships across departments.

• Communicate effectively in both written and verbal formats, including the ability to present information to senior leaders and interact with internal departments and external agencies.

• Be comfortable working with data and technology, including Microsoft Word, PowerPoint, Excel, and email applications.

• Demonstrate advanced Microsoft Excel skills for analysis, reporting, and performance management.

• Be able to operate effectively in a complex healthcare environment while balancing strategic priorities with detailed operational execution.

• Demonstrate the judgment, collaboration, and leadership skills required to influence stakeholders and drive organization-wide improvements.

Benefits:

• Annual hiring range of $114,004–$219,960 USD.

• Fully remote work arrangement.

• Full-time daytime schedule.

• Comprehensive healthcare benefits, including medical, dental, and vision coverage, subject to eligibility requirements.

• Generous paid time off.

• Retirement savings benefits.

• Education assistance and professional development opportunities.

• Wellness and employee support programs.

• Opportunity to lead system-wide denial prevention, recovery, and appeals initiatives.

• Exposure to complex healthcare revenue cycle, reimbursement, payer, compliance, and clinical operations.

• Cross-functional collaboration with senior clinical, managed care, case management, compliance, reimbursement, and operational leaders.

• Opportunity to drive measurable improvements in denial reduction, reimbursement, operational efficiency, and financial performance.