Sr Director, Clinical Solutions

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

This is a REMOTE position within the US only.

Travel Requirements: Quarterly, to client sites and the NJ office for team meetings.

The Senior Director of Clinical Denials focuses primarily on quality assurance, process improvement and client health and satisfaction. Ensure production and quality metrics are met for all clients, while ensuring positive staff morale and development.

The ideal candidate would be a manager or Director with strong client engagement and relationship management skills, including experience in communication, presentations, and reporting. Ideal background includes exposure to hospital revenue cycle denials, preferably in a leadership role overseeing a denial management team. Operational oversight with a client-facing focus is essential. The role is suited for someone looking to grow, with broad exposure to relevant functions even if not all were direct responsibilities.

• Work closely with AVP to meet client expectations.
• Partner with Managers & Supervisors to ensure that Team Member engagement, performance and development are top priority.
• Partner with Managers & Supervisors to create and document best policies and guidelines for effective performance.
•  Partner with AVP on client engagement tasks, which include creating and presenting reporting packages.
• Ensure production, quality and effective scores are accurately captured, tracked, and feedback is provided to Team Members in a clear and timely manner.
• Oversee that team special projects are executed in a timely and effective manner to ensure quality for client health.
• Guide and develop Supervisors in all aspects of Team Member performance management including developing effective action plans, addressing performance challenges in a positive and supportive manner.
• Calibrate audit process to ensure quality check is maintained.
• Communicate with management on team member performance/improvement opportunities.
• Work closely with leadership to ensure best training practices are executed.
• Other duties as assigned.

MINIMUM QUALIFICATIONS & REQUIREMENTS:

• At least five years of relevant work experience, including direct people management
• Previous experience in a client facing role on the provider side of the healthcare domain
• MUST have denials management experience on the provider side of the healthcare domain
• DRG Downgrade experience highly preferred
• Strong knowledge of the Revenue Cycle Management industry
• Experience managing a remote hourly workforce preferred
• Basic Outlook, Word and Power Point skills (ability to create emails, schedule meetings and prepare documents and presentations)
• Intermediate Excel skills (knowledge of functions such as vlookup, sumif, countif, pivot tables, basic formulas)
• Must possess excellent organizational, problem solving, critical thinking, conflict resolution and management skills
• Ability to work both independently and with a team
• Ability to actively listen and effectively express ideas verbally and in writing
• Ability to plan, organize and distribute work assignments
• Ability to train, mentor, lead, motivate and develop team members

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.