Registered Nurse Clinical Operations

Leading clinical operations for Itemized Bill Review (IBR), the remote Associate Director of Clinical Operations will manage a team, drive clinical review strategies, and ensure compliance with CMS guidelines while leveraging extensive expertise in healthcare revenue cycle and facility reimbursement. Key responsibilities: Oversee day-to-day clinical operations for facility claim reviews and manage clinical staff to meet productivity and quality goals Serve as a senior clinical resource for complex claim reviews, ensuring compliance and identifying reimbursement opportunities Act as the primary clinical subject matter expert for the IBR product, participating in discussions on reimbursement and billing issues Required qualifications: Active, unrestricted Registered Nurse (RN) license 5+ years of experience in healthcare revenue cycle, payment integrity, or facility reimbursement 2+ years of experience reviewing inpatient and outpatient facility claims 2+ years of experience applying CMS guidelines and reimbursement methodologies 1+ year of leadership experience managing clinical staff and leading cross-functional initiatives