Registered Nurse Clinical Operations

Job Summary

Leading clinical operations for Itemized Bill Review (IBR), the remote Associate Director of Clinical Operations will manage a team, drive clinical review strategies, and ensure compliance with CMS guidelines while leveraging extensive expertise in healthcare revenue cycle and facility reimbursement.

Key responsibilities:

• Oversee day-to-day clinical operations for facility claim reviews and manage clinical staff to meet productivity and quality goals
• Serve as a senior clinical resource for complex claim reviews, ensuring compliance and identifying reimbursement opportunities
• Act as the primary clinical subject matter expert for the IBR product, participating in discussions on reimbursement and billing issues

Required qualifications:

• Active, unrestricted Registered Nurse (RN) license
• 5+ years of experience in healthcare revenue cycle, payment integrity, or facility reimbursement
• 2+ years of experience reviewing inpatient and outpatient facility claims
• 2+ years of experience applying CMS guidelines and reimbursement methodologies
• 1+ year of leadership experience managing clinical staff and leading cross-functional initiatives