Director, Clinical Operations

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

 

JOB SUMMARY: This position is responsible for directing all aspects of the clinical operations department's coding team and ensuring the team's successful completion of recurring coding tasks and project work, as applicable. This position will work closely with the Company's clinical physician leadership team to help the clinical team identify inaccurate coding and other health care claim errors. This position will manage a team responsible for using coding knowledge to review retrospective, concurrent, and prospective claims on behalf of payers. This position will also develop, track and monitor coder productivity, metrics, and team performance and improvement.   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.). Qualifications JOB REQUIREMENTS (Education, Experience, and Training):   * Minimum high school diploma. Bachelor's degree in healthcare, business, or related field preferred
* Minimum 10 years' experience in a clinically related field including but not limited to: complex hospital and medical billing procedures and coding, auditing, nursing, radiology, laboratory, pharmacy, or physician assistant.
* Minimum 6 years' leadership role with people management responsibilities.
* Current coding certification by the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) or medical license (RN, MD).
* Extensive knowledge of inpatient/outpatient hospital billing and claims data including UB-04's, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-10 diagnoses and procedure codes, DRG, APC's.
* Knowledge of commonly-used medical data resources
* Knowledge of Worker's Comp, Auto Medicare and Government sponsored programs (such as Medicare or Medicaid)
* Knowledge of provider billing and collection practices
* Communication (verbal, written and listening), teamwork, leadership, mentoring, management, interpersonal and organizational skills
* Ability to display leadership qualities, putting team and company success first at all times
* Ability to model a willingness to do what it takes to help the team succeed in achieving its goals
* Ability to commit to providing a level of customer service within established standards
* Ability to provide attention to detail to ensure accuracy including mathematical calculations
* Ability to analyze data and arrive at a logical conclusion
* Ability to identify issues and determine appropriate course of action for resolution
* Ability to display professionalism by having a positive demeanor, proper telephone/email etiquette and using proper language and tone.
* Ability to elicit trust and credibility with all levels of the organization
* Ability to use software and hardware related to job responsibilities, including MS Office Suite, online coding tools, and database software.
* Ability to work with accuracy in a fast-paced environment
* Ability to adjust/alter workflow for both personal and team workloads to meet deadlines
* Ability to manage highly trained clinical coding and nursing personnel
* Ability to work collegially with health care professionals, including physicians
* Ability to work independently and handle confidential information
* Ability to process detailed verbal and written instructions  

BENEFITS

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

 

Your benefits will include:

· Medical, dental and vision coverage with low deductible & copay

· Life insurance

· Short and long-term disability

· Paid Parental Leave

· 401(k) + match

· Employee Stock Purchase Plan

· Generous Paid Time Off – accrued based on years of service

o WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service

· 10 paid company holidays

· Tuition reimbursement

· Flexible Spending Account

· Employee Assistance Program

· Summer Hours

· Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits

  As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.  

APPLICATION DEADLINE

We will generally accept applications for at least 15 calendar days from the posting date or as long as the job remains posted.