Denials Management Specialist

Nahsedfw; Dallas (TX); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Health coverage

Retirement plan match

Paid parental leave

Caregiver leave

Adoption and surrogacy reimbursement

Job summary

Children's Health in Dallas seeks a Denials Management Specialist to lead denial resolution efforts across medical, authorization and reimbursement domains. The role requires collaboration with Utilization Management and other teams, with a hybrid schedule (remote with onsite 2x/month) in a pediatric health system rooted in Dallas.

The ideal candidate has RN licensure, at least 3 years in denial/authorization management, and is skilled in payer policy navigation and appeal strategies.

Qualifications

• Minimum 3 years in authorization, UM, CM, or denial management.
• Minimum 5 years of clinical nursing experience preferred.
• RN licensed with active credentialing.

Responsibilities

• Independently manage peer-to-peer reviews, expedited appeals, standard appeals and retrospective reviews.
• Apply clinical judgment to evaluate medical necessity, authorization criteria and supporting documentation.
• Maintain knowledge of payer policies, authorization requirements, appeal rights and reimbursement rules.
• Monitor and analyze denial trends by payer, diagnosis and service type to identify root causes.
• Partner with revenue, managed care, patient access, pharmacy and clinical teams to resolve denials.
• Serve as a subject matter expert and educate team members on denial and appeal workflows.

Skills

Authorization/denial management

Clinical nursing experience

Education

Bachelor's degree or equivalent experience

RN license

Job description

Under the direction of departmental leadership, the Denials Management Specialist plays a critical role in managing medical, authorization and reimbursement-related denials. The role independently navigates complex payer requirements, applies clinical judgment to appeal strategies, analyzes denial trends and collaborates across teams to resolve denials efficiently.

Department: Utilization Management. Location: Children's Health Trinity Towers. Shift: Full-time, Monday through Friday, 8:00a to 5:00p. Job type: Remote, with onsite attendance required 2 times a month.

What you'll do

• Independently manage peer-to-peer reviews, expedited appeals, standard appeals and retrospective reviews
• Apply clinical judgment to evaluate medical necessity, authorization criteria and supporting documentation
• Maintain working knowledge of payer policies, authorization requirements, appeal rights and reimbursement rules
• Monitor and analyze denial trends by payer, diagnosis and service type to identify root causes
• Partner with revenue, managed care, patient access, pharmacy and clinical teams to resolve denials
• Serve as a subject matter expert and educate team members on denial and appeal workflows

What you bring

• At least 3 years of authorization, UM, CM or denial management experience required
• At least 5 years of clinical nursing experience preferred
• Four-year bachelor's degree or equivalent experience required
• RN license required
• Health coverage Employee portion of medical plan premiums covered after 3 years
• Retirement 4%-10% employee savings plan match based on tenure
• Paid parental leave Up to 12 weeks
• Caregiver leave Paid caregiver leave
• Family support Adoption and surrogacy reimbursement

About the employer

Children's Health

Children's Health is a Dallas-based pediatric health system with a mission to Make Life Better for Children. Through cutting-edge treatments and its affiliation with UT Southwestern, it delivers patient and family care across North Texas and invests in the broader community.

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Job summary Denials Management Specialist