Director of Clinical Operations

Job Summary

A company is looking for a Director of Clinical Operations & Coding.

Key Responsibilities

• Lead coding governance and review for accuracy and compliance in molecular diagnostic testing
• Oversee medical necessity reviews for prior authorizations and appeals, ensuring compliance with payer policies
• Develop and maintain standardized templates for prior authorizations and appeals to improve operational efficiency

Required Qualifications

• Bachelor's degree in Nursing, Health Sciences, Healthcare Administration, Public Health, or a related field
• 7+ years of experience in revenue cycle, clinical operations, medical necessity review, or coding oversight
• Expertise in CPT and ICD-10 coding review and audit practices
• Proven ability to create and implement standardized documentation and operational processes
• Strong analytical skills with the ability to translate complex payer policies into operational guidance