CorroHealth
Director, Clinical Denials Management (RN or MD/DO) (FT/REMOTE)
US - Remote · Director
Sponsorship not specifiedDetected 5 days ago
Financial ModelingProcess ImprovementPerformance ManagementLeadershipCommunicationCollaboration
About the role
- The Manager of Clinician Appeals is a clinical leader responsible for the strategic oversight and operational execution of the appeals letter writing and client education engagement.
- This position works closely with internal leadership, administrative operations, and external clients to ensure best-in-class service delivery in a dynamic revenue cycle environment.
- Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties.
Responsibilities
- Build, lead, and scale the clinical letter writing team, ensuring appropriate staffing levels aligned to current and forecasted client demand.
- Define and implement the team's leadership structure and workflows.
- take corrective action as needed to maintain high performance.
- Lead the team responsible for clinical review and oversight of appeal content.
- Develop and continuously improve robust QA programs
- Drive clinical consistency across all client deliverables.
- This position may perform all or most of the primary duties listed below.
- Enforce quality and productivity standards; take corrective action as needed to maintain high performance.
- Partner with administrative operations leadership to ensure seamless movement of cases through the appeals workflow.
- Maintain a proactive awareness of client demand changes and implementation timelines to ensure clinical team capacity aligns with needs.
Requirements
- Experience working with offshore teams, a clinical background such as RN, coding expertise, or experience in CDI or DRG validation.
- Minimum 8+ years of clinical experience with at least 5 years in a leadership role within appeals, utilization management, clinical documentation improvement (CDI), or similar RCM functions.
- Strong understanding of financial models and operational KPIs in the revenue cycle industry.
- RN, required
- active, unrestricted medical license (any state) preferred.
- DRG Downgrade experience is mandatory.
- Strong knowledge of payer appeals processes, healthcare regulations, and documentation standards.
- Demonstrated success in managing clinical teams in a high-volume, fast-paced environment.
- Proven experience developing QA programs and implementing clinical workflow improvements.
- Exceptional communication, collaboration, and leadership skills.
Nice to have
- Knowledge of DRG coding, CDI best practices, and payer denial trends.
- Experience working with both domestic and global teams.
- Working Conditions:
- Must be able to work in a matrixed, cross-functional environment
- Equipment provided
- 401k matching program
- DRG Downgrade experience is highly preferred, and you must be able to analyze denial types, identify root causes, and deliver actionable feedback that helps prevent future denials.
Compensation
- Competitive annual salary
- 9 paid annual holidays
Benefits
- Medical/Dental/Vision Insurance
- Paid Paternity & Maternity leave programs
- Life Insurance
- Long term disability
- Short term disability options
- Tuition reimbursement
- FTO: Flex Unlimited Annual PTO
Company info
- Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
- We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
- Our purpose is to help clients exceed their financial health goals.
- Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs.
- Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
- We build long-term careers by investing in YOU.
- We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
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This listing is sourced directly from CorroHealth's careers page and normalized into a canonical job model.