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.