The Role
The Clinical Director is responsible for identifying hospital underpayments, submitting appeals for additional reimbursement, and ensuring quality standards. They also coach team members, participate in meetings, and manage client relationships while adhering to HIPAA.
Summary Generated by Built In
Essential Duties and Responsibilities:
- Leverage data-mining and reimbursement modeling tools to review and identify underpayments/denials which are due for additional reimbursement from the payer
- Identify and document underpayment root causes by contacting payers via phone and through review of client systems and account documentation
- Submit written appeals detailing expected reimbursement and clearly outlining reasons for additional payment, including citation of contract language, policies, and industry standards in a persuasive manner
- Gain knowledge of general hospital policies and procedures, hospital underpayments, and revenue cycle maximization opportunities
- Ensures productivity and quality standards are met
- Participate in internal client meetings, contributing to a greater understanding of project and initiative progress
- Coaches/Partners with other team members
- Identify and research new placement concept opportunities
- Assist in client reporting
- Strict adherence to HIPAA privacy and security rules, including following MRI policy at all times
- All other duties as assigned
Requirements
Knowledge, Skills, Abilities:
- Strong analytical, technical, and creative problem-solving skills
- Demonstrated ability to analyze, understand, and communicate complex issues and trends.
- Demonstrated interpersonal skills. Ability to articulate goals clearly and expectations to team members and communicate results to MRI Management.
- Customer-service orientation with the ability to interact with a range of personalities independently and styles to establish effective relationships internally & externally.
- A positive and optimistic attitude that is maintained despite tight deadlines and competing priorities.
- Genuine enthusiasm for working for an evolving start-up with the ability to embrace new ideas.
- Ability to demonstrate high personal ethics consistently, integrity, prudence, energy, initiative, and self-confidence.
Education/Experience:
- Bachelor’s degree with Healthcare, Business, or relevant background preferred
- Relevant professional experience within the Hospital/Insurance industry preferred
- Expertise within the MS Office Suite including Excel, Word, Outlook, and Access preferred
Benefits
Dental, Medical, Vision and 401K
Skills Required
- Bachelor's degree in Healthcare, Business, or relevant background
- Relevant professional experience in the Hospital/Insurance industry
- Expertise in MS Office Suite including Excel, Word, Outlook, and Access
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The Company
What We Do
Allen Spolden specializes in clinical research operations management and provides tailored workforce solutions for clinical research organizations, pharmaceutical, biotech, and healthcare sectors. They offer services in clinical research, data management, regulatory affairs, and talent acquisition.
