Revenue Cycle Clinical Director

Moffitt Cancer Center; Tampa (FL); On-site; USD 114,000 - 174,000; Full time

Job summary

Moffitt Cancer Center in Tampa, FL seeks a Revenue Cycle Medical Director to oversee Peer to Peer Review, financial clearance and medical necessity checks. You will coordinate with payors and internal clinical teams to secure timely reimbursement and educate physicians on denials.

The role requires extensive knowledge of CMS regulations, payer policies and oncology billing, with leadership to guide the Financial Clearance unit and nursing staff.

Qualifications

• Bachelor’s degree in PA or APRN; MD may qualify but not required.
• At least 10 years of experience; 3+ years as PA/APRN.
• Knowledge of payor authorizations and peer to peer reviews.

Responsibilities

• Lead Peer to Peer Review and financial clearance for medically necessary services.
• Communicate with payors and clinical teams to obtain authorizations.
• Educate physicians on denials and payer policies.
• Maintain knowledge of CMS rules and reimbursement processes.

Skills

Communication

Leadership

CMS regulations

Payor processes

Problem solving

Education

Bachelor's degree in Physician Assistant / APRN

MD degree qualifies

Tools

Cerner Millennium

Soarian Financials

Oncore

Job description

Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer.As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt employs some of the best and brightest minds from around the world. Join a dedicated team of nearly 11,000 who are shaping the future we envision. Moffitt has been recognized as a Best and Brightest Company to Work For in the Nation and is continually named one of the Tampa Bay Times’ Top Workplaces.SummaryThe Revenue Cycle Medical Director performs 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 authorizations 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 payor directly or reaches out to ordering physician 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 authorizations and peer to peer process. Educates and advises providers and their clinical teams, Nursing team, payer strategies, pharmacy and Financial Clearance unit team.Minimum Education:Bachelor's Degree in Physicians Assistant (PA) or Advanced Practice Registered Nurse (APRN)MD degree would also qualify but is not required or preferredMinimum Experience:Minimum of ten (10) years’ experience to include: A minimum of three (3) years' experience as a Physician Assistant (PA) or Advanced Practice Registered Nurse (APRN) and the remaining experience can be as RNLicensure Certification Needed:APRN or PAMinimum Skills/Specialized Training Required:Excellent communication and customer service skills, interpersonal ability and demonstrated leadership skills to regularly interact with administration, medical staff, nursing personnel, other hospital professionals, external health care professionals and payors.Knowledge of CMS regulations; third party reimbursement processes, policies and regulations, charging and coding guidelines. Excellent problem-solving and conflict resolution skills. Knowledge of health insurance payment processes, including medical necessity, authorization and denials. Understanding of government healthcare programs.Preferred Experience:Oncology experience in multiple disciplines, including administration of chemotherapy, radiation therapy, surgery or clinical trials. Experience with the treatment of a broad range of different cancers, including breast, lung, melanoma, leukemia, lymphoma, colorectal, stomach, liver, pancreas, neuroendocrine tumors, head and neck, endocrine, prostate, kidney, bladder, endometrial, cervical, ovarian, endocrine, brain tumors, etc.Preferred Skills/Specialized Training:Proficiency with Cerner Millennium(Capstone and Powerchart)Proficiency with Soarian FinancialsProficiency with OncoreSalary Range$113,859.20 - $173,638.40Salary ranges posted for this position represent the expected base pay range for the role. Actual compensation may vary based on location and a variety of job-related factors, including experience, skills, education, and internal equity among Team Members in similar positions.We are committed to maintaining fair and equitable pay practices and regularly review compensation to ensure alignment across our workforce.Moffitt Career SiteIf you have the vision, passion, and dedication to contribute to our mission,then we have a place for you!1. Equal Employment OpportunityMoffitt Cancer Center is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, or protected veteran or disabled status. We seek candidates whose skills, and personal and professional experience, have prepared them to contribute to our commitment to diversity and excellence.2. Reasonable AccommodationFederal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment. Moffitt endeavors to make moffitt.org/careers accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact one of the Human Resources receptionists by phone at 813-745-7899 or by email at [e-mail]. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.Read more information about your EEO rights under the law.Transparency in Coverage Rule