Director of Clinical Appeals & Denials Tide Health Group is seeking an experienced Director of Clinical Appeals & Denials to oversee clinical audits, denials, and appeals across our organization. This role is ideal for an LPN, RN, or therapy professional with strong knowledge of CMS regulations, Medicare requirements, medical necessity, and the audit/appeals process . Compensation based on experience! Key Responsibilities Manage and prepare clinical denials, appeals, and audit responses . Review medical records for medical necessity, skilled need, and CMS compliance . Research and apply CMS regulations and payer guidance to support appeals. Identify denial trends and opportunities to improve documentation and prevent future denials. Collaborate with clinical, therapy, operational, and reimbursement teams. Provide education and feedback related to documentation and compliance. Track appeal deadlines, outcomes, and trends. Qualifications Clinical background as an LPN, RN, PT, OT, SLP, PTA, or COTA . Knowledge of CMS regulations and Medicare requirements is required. Experience with audits, denials, medical record review, and/or appeals is required. Strong clinical documentation review and analytical skills. Excellent written communication and attention to detail. SNF, LTC, rehabilitation, or post-acute experience strongly preferred. We are looking for someone who can connect the clinical record to CMS requirements , identify documentation gaps, and develop strong, well-supported appeals while helping our teams prevent future denials.

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Flexible schedule Flexible spending account Health insurance Health savings account Life insurance Paid time off Referral program Vision insurance

Work Location:

In person