National Appeals and Denials Manager

Are you an experienced RN with a strong background in hospice documentation, audits, and compliance? We’re looking for a detail-oriented, solutions-driven nursing professional who is passionate about ensuring quality care and protecting reimbursement through accurate documentation and timely appeals.

As the National Appeals and Denials Manager, you’ll play a vital role at the intersection of clinical operations, compliance, and billing. Reporting to the Regional Vice President of Clinical Operations, you’ll lead efforts to respond to medical record requests, manage appeals, analyze denial trends, and collaborate with cross-functional teams to support regulatory readiness and operational excellence.

Bristol Hospice is a nationwide industry leader committed to providing a family-centered approach in the delivery of hospice services throughout our communities. We are dedicated to our mission that all patients and families entrusted to our care will be treated with the highest level of compassion, respect, and dignity. For more information about Bristol Hospice, visit bristolhospice.com or follow us on LinkedIn.

Our Culture

Our culture is cultivated using the following values:

• Integrity: We are honest and professional.
• Trust: We count on each other.
• Excellence: We strive to always do our best and look for ways to improve and excel.
• Accountability: We accept responsibility for our actions, attitudes, and mistakes.
• Mutual Respect: We treat others the way we want to be treated.

On an Average Day You Will:

(includes but not limited to)

• Review and respond to ADRs from Medicare, Medicaid, and other regulatory entities (TPE, SMRC, UPIC, ZPIC, OIG)
• Track and monitor records requests in systems such as Waystar, NGS, CGS, Palmetto, and Quantum
• Collaborate with local teams to gather and validate documentation for appeals and audits
• Analyze denial trends and provide insights to leadership for targeted education and process improvement
• Prepare, submit, and follow up on appeals in coordination with clinical and billing teams
• Ensure all appeal and record request deadlines are met with complete and accurate submissions
• Partner with billing, informatics, and regional leaders to ensure data accuracy and transparency
• Communicate regularly with cross-functional teams to identify and resolve compliance or documentation gaps
• Contribute to continuous improvement efforts through QAPI and staff education
• Support organizational compliance through policy implementation and proactive issue identification
• Conduct annual evaluations for direct reports and provide ongoing performance feedback
• Maintain open communication through team meetings, email, and real-time messaging
• All other duties as assigned

Requirements: 

• Active Registered Nurse (RN) license required
• Minimum 5 years of nursing experience
• At least 1 year of hospice experience required
• Hospice administrative experience strongly preferred

Our Ideal Candidate Has the Following Skills and Knowledge: 

• In-depth understanding of federal, state, and accreditation standards specific to hospice care
• Strong working knowledge of the appeals and denials process, including experience with TPE, SMRC, UPIC, ZPIC, OIG, Medicaid, and Medicare Advantage audits
• Proven ability to analyze denial trends and translate findings into actionable education and process improvement
• Proficiency in tracking systems and payer portals such as Waystar, NGS, CGS, Palmetto, and Quantum
• Clear and professional verbal and written communication skills
• Strong attention to detail and accuracy in documentation and reporting
• Ability to lead, collaborate, and build effective working relationships with cross-functional teams
• Adaptability to shifting priorities and deadlines in a fast-paced, compliance-driven environment
• Experience with staff training, development, and performance evaluation
• Commitment to ethical standards, patient confidentiality, and organizational transparency

We Got the Perks: 

• Tuition Reimbursement
• PTO and Paid Holidays
• Medical, Dental, Vision, Life Insurance, and more
• HSA & 401(k) available
• Mileage Reimbursement for applicable positions
• Advanced training programs
• Passionate company culture committed to the highest standard of care in the hospice industry

Join a Team that embraces the reverence of life!

EEOC Statement

Bristol Hospice is an equal-opportunity employer. Our success depends upon our ability to create and maintain a diverse and supportive work environment where individuality is promoted. Bristol puts high priority on the worth of every person. We do not base our hiring decisions on race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics