Director, Clinical Operations

JOB ROLES AND RESPONSIBILITIES:

1. Direct and manage a team of nurses and coders who are:
o Providing support for negotiating desired savings based on product rules and payer guidelines
o Reviewing submitted medical documentation for bill reviews and adding coding input
o Contributing to or wholly performing both small- and large-scale coding projects
2. Create, institute and monitor performance metrics for nurses and coders performing claim reviews.
3. Work closely with:
o physician leaders to coordinate workflow between the physician team and clinical coding teams.
o the medical review team as needed or required to provide subject matter expertise on the most complex claims for medical review and/or approval on a case-by-case basis to maximize savings.
4. Collaborate regularly with analytics team on new and researched coding and editing topics, claim factors, and other applicable reference/source materials to ensure consistency across departments.
5. Partner with internal "clients", including Operations support staff, Clinical staff, Negotiators, and other staff as applicable.
6. Oversee, lead and participate in projects, initiatives, and presentations, including new client account establishment and pilot programs, often acting as a Subject Matter Expert (SME).
7. Manage and direct departmental performance to establish, meet, maintain and monitor metrics within turnaround time limits.
8. Direct the hiring, orientation and mentoring of employees.
9. Identify issues, problems, and opportunities, bring suggestions, and implement solutions to improve department's effectiveness and efficiency
10. Develop, implement and manage both short- and long-term goals, objectives, policies and procedures based on current and future trends. Stay abreast of industry and/or customer changes and communicate as appropriate.
11. Select, develop, and evaluate staff to ensure the efficient operation of department.
12. Collaborate, coordinate, and communicate across disciplines and departments.
13. Ensure compliance with HIPAA regulations and requirements.
14. Demonstrate Company's Core Competencies and values held within.
15. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
16. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

The salary range for this position is $104k-120K annually. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

JOB SCOPE:
The incumbent manages a team of clinical coders and nurses as that team works on matters of significant financial importance, using coding guidelines to aid in the profitable resolution of claims on behalf of the Company's Clients, completing routine bill reviews, and participating in audit projects. The incumbent utilizes discretion and judgment to judiciously manage the team in situations where guidelines may not apply. Also, this job has regular interaction and coordination with clinical teams to better understand the medical procedures involved, and to explain coding issues. The incumbent is a subject matter expert in coding and a mentor to team members under the incumbent's management. The incumbent will devise and institute team performance metrics and track and monitor coding team case review volumes. The incumbent will closely coordinate with senior physicians and analytics to ensure close coordination between coding team and physician team workflows and processes. This is a people management job with authority for all HR actions (hiring, firing, discipline, training, etc.).