Florida Licensed Revenue Cycle Director

Job Summary

To enhance patient care and secure reimbursement, the full-time remote Florida Licensed Revenue Cycle Director will manage the Peer to Peer Review Program, perform financial clearance and medical necessity checks, and communicate with clinical counterparts and insurance payors.

Key responsibilities

• Oversee all peer to peer conversations for medically necessary services and provide education on upheld denials to physicians
• Conduct clinical reviews of medical records to ensure documentation sufficiency and collaborate with payors to overturn denials
• Educate providers and clinical teams on payer strategies, regulations, and the authorization process

Required qualifications

• Bachelor's Degree in Physician Assistant (PA) or Advanced Practice Registered Nurse (APRN); MD degree is acceptable but not preferred
• Minimum of ten (10) years of experience, including three (3) years as a PA or APRN
• Current licensure as an APRN or PA
• Knowledge of CMS regulations and third-party reimbursement processes
• Experience in oncology is preferred, including familiarity with various cancer treatments