Sr. Director, Clinical Denials - REMOTE

About Enable Comp

Enable Comp 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, Enable Comp 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, Enable Comp 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. Enable Comp 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.

• 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 Inter Qual and MCG Health (formerly Milliman Care Guidelines).
• Represent the organization as a clinical expert in client meetings, audits, and appeal escalations.
• Represent Enable Comp 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…