Director, Preservice Verification

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Oversee, direct, and coordinate all operations of Preservice Verification.

• Identify, convey, and synchronize the overarching strategy for departmental enhancements throughout the system.

• Create departmental strategies to achieve overall PRMO objectives and performance indicators.

• Collaborate with entity leadership, departmental managers, revenue managers, and physicians to pinpoint opportunities for enhancing revenue cycle performance.

• Develop and enforce enterprise-level policies and procedures, ensuring adherence to state and federal regulations, as well as all payor requirements.

• Analyze monthly trends in denials and write-offs related to registration/eligibility, authorization, and medical necessity.

• Formulate and execute strategies to minimize denials and write-offs.

• Oversee internal control performance for the Preservice Verification department and its associated functions and workflows.

• Collaborate with other departments as necessary to ensure compliance.

• Actively manage outsourcing and vendor partnerships.

• Monitor costs and assess the utilization of any vendor relationships linked to the department's cost center.

• Assist in identifying new technologies that will enhance financial service operations.

• Oversee human resources management, including onboarding, succession planning, recruitment strategies, and employee engagement.

⛳️ Requirements

• A Bachelor's degree is required.

• A Master's degree is preferred.

• A minimum of 8 years of progressive experience in clinical, administrative, or consulting roles within a provider or payor healthcare environment is necessary.

• At least 5 years of experience in managing people or projects.

• Extensive experience working with clinical providers is required.

• A solid understanding of payor coverage requirements related to eligibility, authorization, and medical necessity.

• Knowledge of procedure and diagnosis coding, as well as case management and utilization review functions.

• General understanding of all revenue cycle functions and their interrelationships.

• Strong leadership presence and skills.

• Demonstrated ability in building and leading teams.

• Capacity to collaborate and work cooperatively with others.

• Strong written and verbal communication skills.

• Epic experience is preferred; proficiency in MS Office applications (Word, Excel, Visio, Access) is required.

🏝️ Benefits

• Health insurance.

• Flexible work arrangements.

• Professional development opportunities.