- Location
- Dallas, TX · Hybrid
- Job type
- Full-time
- Level
- Mid
About the role
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
Benefits
- 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 HealthChildren'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.