REVENUE CYCLE CLINICAL DIRECTOR in Tampa, Florida at H. Lee Moffitt Cancer Center

Position Highlights and Responsibilities:

• The Revenue Cycle Dir peforms all aspects of the Peer to Peer Review Program, financial clearance and medical necessity check. Communicates with clinical counterparts at the payor and within the cancer center. Organizes and prioritizes encounters needing financial clearance due to pending Peer to Peer reviews to ensure timely patient care and secure reimbursement.
• This position is responsible for performing all peer to peer conversations for medically necessary services on behalf of ordering providers as well as providing feedback and education to physicians on upheld denials.
• Works directly with insurance companies (payors) using clinical expertise to obtain authorization and overturn pre-service denials. Reduces/minimizes the need to escalate cases to Moffitt physicians. Performs clinical review of medical records to determine if documentation is sufficient and contacts payors directly or reaches out to ordering physicians and/or clinical team to obtain additional information for the case prior to contacting payor to overturn the denial.
• Maintains a deep knowledge of payor classifications, rules and criteria for authorizationw and peer to peer process. Educates and advises providers and their clinical teams, Nursing team, payer strategies, pharmacy and Financial Clearance unite team.

Credentials and Experience:

• Bachelor's degree - field of study: Physicians Assistant (PA) or Advanced Practice Registered Nurse (APRN)
• Minimum of ten (10) years experience to include : a minimum of 3 years experience as a Physician Assistant (PA) or Advanced Practice Registered Nurse (APRN) and the remaining experience can be as a RN