Director of Financial Operations

3 days ago

Danbury, Connecticut, United States Nuvance Health Full time
Job Summary

Nuvance Health is seeking a highly skilled and experienced professional to lead our Financial Clearance Department. As the Director of Financial Operations, you will be responsible for overseeing the daily operations and functions of financial clearance, including insurance verification, authorization, pre-registration, price estimation, and single case agreements.

Key Responsibilities
  • Oversee and manage the operational functions of financial clearance operations, ensuring efficient and effective processes.
  • Partner with revenue cycle and non-revenue cycle leaders to collaborate on workflow and establish best practices to secure revenue for the network.
  • Meet strategic goals for rate of clearance prior to time of service, pre-service collections by procedure type, and aggressively low denial and error rates meeting established KPIs.
  • Identify and remediate denials, submit appeals, and track success towards future prevention goals.
  • Oversee and support the estimator tool for the Network, adhering to all regulatory standards and organizational policies, procedures, and guidelines.
  • Accountable for overseeing the pre-bill function, including rejections and EBEW Patient Access errors for Hospital and Medical Group claims.
  • Collaborate with decentralized areas for education opportunities on denial prevention and effective appeal writing.
  • Manage a complex group of relationships with clinicians, patients, employers, insurance companies, health plans, and managed care.
  • Meet with stakeholders on a regular basis to identify opportunities for improvement leading to patient and physician satisfaction.
  • Assist in building payer-specific rules through knowledge of payers, insurance eligibility process, and the financial clearance workflow.
  • Work collaboratively with managed care and business office to identify opportunities and provide feedback to improve reimbursement.
  • Manage the budget for financial clearance departments.
  • Fulfill all compliance responsibilities related to the position, ensuring all financial clearance processes are in line with state and federal requirements.
  • Manage staff, including hiring, conducting performance reviews, counseling, disciplinary action, and overseeing staff educational development.
  • Work with clinical areas to support and provide guidance on best practices for revenue cycle opportunities.
Requirements
  • Bachelor's degree and 7-10 years of healthcare revenue cycle experience and management experience.
  • Master's degree and 7 years of healthcare revenue cycle experience preferred.
  • National Association of Healthcare Access Management CHAM certification and AAPC Certified Professional Coder (CPC) certification preferred.

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