N/A
Director of CRC Shared Services
2 years ago
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Serves as senior leader for all clinical denials / appeals related activities across all clients. Accountable for successful appeals. Oversee performance across all clients. Identify opportunities for and leads performance improvement activities. Identifies and develops additional clinical service offerings. Accountable for recruiting and developing leadership team and staff. Collaborates with client executives
- Performance Targets– Full responsibility for achieving performance targets. Analyzes outcomes & process metrics
- Operations– Works with operations, Conifer leaders and external partners to identify opportunities for improvement
- Issues & Escalations– Develops and oversees internal / external action plans
- Collaboration– Collaborates with internal and external process leaders. Attends client-facing meetings to resolve concerns and share insights
- Strategizing– Strategizes with Client Delivery Executives and operations leaders to set performance targets, identify opportunities and develop new service offerings
- Goals– Works with VP to create strategic goals and with Director to develop tactical plans for implementation
- Training and Development– Develops and mentors leaders; provides professional development opportunities
- Performance Management– Supports operations leaders in management and disciplinary actions
- Culture– Fosters high-performance culture; maintain environment that motivates morale, engagement and growth
- Leadership Support – Supports VP in preparing materials, progress and performance reports for internal and client discussions
Knowledge:
- Government and Commercial Payers – NCDs/LCDs and ability to research payer specific policies
- Technology– Experience with multiple CM / HIM technology solutions and MS Word, Excel and PowerPoint
- Coding and DRG – Familiar with DRG classification and reimbursement structures
- Communication– Written and verbal communication skills
- Revenue Cycle – Understanding of healthcare and revenue cycle services as it relates to payer denials
- Teaching– Ability to conduct on-line education sessions
- Other – Flexible, innovative and highly adaptable to dynamic business environment, catalyst for change. Highly engaged and supportive of leadership. Role model for Conifer values and guiding behaviors.
- Analytics & Performance Improvement– Experience with data, analytics, and performance improvement activities
- Organizational Skills– Effectively manages competing priorities. Ability to formulate and develop new and innovative strategies and services
- Medical Necessity Tools– Familiar with medical necessity guidelines and their use
Desired Qualifications:
- 4 year college degree in business administration, finance or healthcare administration or equivalent experience, related advanced degree preferred
- 8-10 years of experience and knowledge of provider revenue cycle
- Registered Nurse (RN)
- Utilization Review or Case Management Certification
- Certification as Revenue Cycle Representative (CRCR) or Certified Financial Healthcare Professional (CFHP) – Preferred