Denials Management Specialist

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. 6 open roles on the NAHSE DFW job board childrens.com (opens in a new tab) Job summary Denials Management Specialist #J-18808-Ljbffr Nahsedfw