Sr. Director, Clinical Denials - Franklin - EnableComp LLC

Description

About EnableComp

EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers' Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient of the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.

Position Summary

The Sr. Director, Clinical Denials, will serve as the primary clinical authority supporting clients with denial prevention, appeal strategy, payer policy compliance, and industry education. This role represents the vendor's clinical expertise and partners with provider clients to optimize revenue integrity, improve appeal outcomes, and reduce denial exposure. The Sr. Director, Clinical Denials, provides advanced consultative guidance, supports process design, mentors internal teams, and ensures delivery excellence in all clinical denial-related engagements. This role requires an experienced clinical professional with extensive inpatient experience, a proven record of collaboration with clinicians and payers, root cause research and identification of denial, and a deep understanding of payer behavior and regulatory requirements.

Key Responsibilities

• Serve as the vendor's lead clinical subject matter expert on clinical denials management and prevention.
• 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.
• Develop and refine clinical appeal strategies and templates to improve success rates.
• Analyze denial trends across multiple clients and provide actionable insights to reduce recurring clinical denials.
• Collaborate with coding, Clinical Documentation Integrity (CDI), and client operations teams to ensure consistency in methodologies and documentation practices.
• Support proposal and implementation teams by contributing clinical expertise to solution design and client onboarding.
• Maintain deep familiarity with Centers for Medicare & Medicaid Services (CMS) regulations, payer guidelines, and medical necessity criteria such as InterQual and MCG Health (formerly Milliman Care Guidelines).
• Represent the organization as a clinical expert in client meetings, audits, and appeal escalations.
• Represent EnableComp as an industry expert at national and regional conferences, networking opportunities, community outreach events, and client meetings.
• Serve as a spokesperson for the company through webinars, speaking engagements, panel discussions, and authored articles.
• Develop white papers, policy briefs, industry reports, and thought leadership content to elevate the organization's presence in the RCM and policy landscape.
• Engage with payers and provider networks to advocate for streamlined administrative processes, and enhanced reimbursement methodologies.
• 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.
• Partner with the sales and client success teams to educate prospective and existing clients on EnableComp's services, value proposition, and regulatory insights.
• Provide in-depth RCM expertise in responding to RFPs, proposals, and client inquiries.
• Conduct training sessions and presentations on complex claims and industry trends for internal teams and clients.

Requirements and Qualifications

• Bachelor's Degree
• 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.
• Excellent written communication and clinical reasoning skills for crafting persuasive appeals and client documentation.
• Strong knowledge of MS-DRG and APR-DRG methodologies, including Severity of Illness (SOI) and Risk of Mortality (ROM) classifications.
• Proficiency with CMS rules, payer contracts, and medical necessity guidelines (InterQual, MCG).
• Regular and predictable attendance.
• Equivalent combination of education and experience will be considered.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Special Considerations and Prerequisites

• Practices and adheres to EnableComp's Core Values, Vision and Mission.
• Executive-level professional presence with the ability to communicate clearly, confidently, and credibly in client-facing settings.
• Strong organizational skills with the ability to manage multiple priorities across complex client and internal environments.
• Willingness to learn, adapt, and model resilience in a dynamic, high-expectation environment.
• Experience working with or supporting multiple hospital or health system clients in a vendor, consulting, or outsourced revenue cycle capacity.
• Familiarity with Electronic Health Record (EHR) systems such as Epic, Cerner, or Meditech, and denials management platforms.
• Coding certifications such as Certified Clinical Documentation Specialist (CCDS), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC) preferred but not required if clinical and denial management expertise is extensive.

EnableComp is an Equal Opportunity Employer M/F/D/V. All applicants will be considered for this position based upon experience and knowledge, without regard to race, color, religion, national origin, sexual orientation, ancestry, marital, disabled or veteran status. We are committed to creating and maintaining a workforce environment that is free from any form of discrimination or harassment.

EnableComp recruits, develops and retains the industry's top talent. As the employer of choice in the complex claims industry, EnableComp takes pride in our continuous commitment to building and maintaining a culture centered around fostering the professional growth and development of our people. We believe that investing in our employees is the key to our success, and we are dedicated to providing them with the tools, resources, and support they need to thrive and grow their career here. At EnableComp, we are committed to living up to our core values each and every day, and we believe that this commitment is what sets us apart from other companies. If you are looking for a company that values its employees and is dedicated to helping them achieve their full potential, then EnableComp is the place for you.

Don't just take our word for it Hear what our people are saying:

"I love my job because everyone shares the same vision and is determined and dedicated. People care about you as a person and your professional growth. There is a genuine spirit of cooperation and shared goals all revolving around helping each other." – Revenue Specialist

"I enjoy working for EnableComp because of the Core Values we believe in. EnableComp stands true to these values from empowering employees to ecstatic clients. This company is family oriented and flexible, along with understanding the balance of work, life, and fun." – Supervisor, Operations