Manager, Clinical Operations

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!

JOB SUMMARY: This position is responsible for managing all facets of the Clinical Operations team, specializing in Quality and Testing for Claims Editing/Payment Integrity, including education, staffing, product evaluation and enhancement, and policies/procedures to ensure smooth and efficient operations.

Job Roles And Responsibilities

• Manage the day-to-day Clinical Operations team including but not limited to the monitoring of individual and staff workload, operational productivity and performance, training, mentoring, motivating and management of workflows.
• Manage and track assigned department workload re-distributing as necessary.
• Implement robust testing procedures to ensure the functionality, integrity, accuracy, and quality of all modifications and enhancements to the editing logic, including:
• Carefully analyzing clinical and technical requirements to clearly define the scope of testing.
• Establishing, developing, and maintaining comprehensive test scenarios, data, checklists, and other essential documentation, all aligned with specific requirements.
• Adopting best practices in software testing methodologies and techniques to guarantee optimal outcomes.
• Examine and resolve incorrect results, identify the root cause, and recommend solutions.
• Produce detailed, accurate documents in a consistent format that demonstrate strong analytical and documentation skills.
• Enhance test-based pre-production validation by effectively using post-production results and team feedback.
• Provide expert guidance and support to team members; serving as Subject matter Expert(SME)
• Effectively collaborate, coordinate and communicate across various disciplines and departments throughout the organization to resolve problems and ensure consistency and accuracy.
• Manage departmental performance to establish, meet, maintain and monitor metrics within turnaround time limits.
• Identify issues, problems, and opportunities, bring suggestions, and implement solutions to improve department's effectiveness and efficiency
• Complete and oversee special projects assigned by leadership.
• Create and distribute goals and standards to staff regularly.
• Participate in the development of policies and procedures based on current and future trends.
• Select, develop, and evaluate staff to ensure the efficient operation of department.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Demonstrate Company's Core Competencies and values held within.
• Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
• The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
  

Job Scope

The incumbent works independently and exercises significant independent judgment. The incumbent will manage staff and help provide thorough and appropriate responses to meet the goals of the department. The incumbent provides input to make critical business decisions, including staffing and process improvement, and impacts day-to-day operations through the oversight of coding reviews and providing direction to staff on individual cases. This is a people management job with authority for all HR actions (hiring, separations, discipline, training, etc.).

,

JOB REQUIREMENTS (Education, Experience, And Training)

• Minimum Bachelor's degree healthcare, business, or related field preferred
• Minimum 7 years' experience in the healthcare industry with a minimum of 4 years in a leadership role with people management responsibilities
• Minimum 2 years’ experience in quality assurance or testing of claim edits, claim adjudication logic, or claim platform functionality
• Experience with Project or Product Management and Agile Methodologies preferred
• Required licensures, professional certifications, and/or Board certifications as applicable - Certified by the American Health Information Management Association in coding (CCA, CCS, RHIA, RHIT) or the American Academy of Professional Coders (CPC, CPC-P, CPC-H)
• Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes)
• Knowledge of Worker's Comp, Auto Medicare and Government sponsored programs (such as Medicare or Medicaid)
• Teaching, mentoring and presentation skills and experience
• Communication (verbal, written and listening), managerial, interpersonal, organizational, time management, problem solving and leadership skills.
• Ability to analyze data and arrive at a logical conclusion
• Ability to identify issues and determine appropriate course of action for resolution
• Ability to display professionalism by having a positive demeanor, proper telephone/email etiquette and using proper language and tone.
• Ability to elicit trust and credibility with all levels of the organization
• Ability to use software and hardware related to job responsibilities, including MS Office Suite, MS SQL or Visual Studio, Team Foundation Server (TFS), online coding tools, and database software.
• Ability to work with accuracy in a fast-paced environment
• Ability to adjust/alter workflow to meet deadlines
• Ability to manage highly trained clinical coding and analytics personnel
• Ability to work collegially with health care professionals, including physicians
• Ability to work independently and handle confidential information
• Ability to process detailed verbal and written instructions
• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone
  
  

Compensation

The salary range for this position $90,000-$110,000 year. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

Benefits

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your Benefits Will Include

• Medical, dental and vision coverage with low deductible & copay
• Life insurance
• Short and long-term disability
• 401(k) + match
• Generous Paid Time Off
• Paid company holidays
• Paid Parental Leave
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program
• Summer Hours
  
  

EEO STATEMENT

MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!

JOB SUMMARY: This position is responsible for managing all facets of the Clinical Operations team, specializing in Quality and Testing for Claims Editing/Payment Integrity, including education, staffing, product evaluation and enhancement, and policies/procedures to ensure smooth and efficient operations.

Job Roles And Responsibilities

• Manage the day-to-day Clinical Operations team including but not limited to the monitoring of individual and staff workload, operational productivity and performance, training, mentoring, motivating and management of workflows.
• Manage and track assigned department workload re-distributing as necessary.
• Implement robust testing procedures to ensure the functionality, integrity, accuracy, and quality of all modifications and enhancements to the editing logic, including:
• Carefully analyzing clinical and technical requirements to clearly define the scope of testing.
• Establishing, developing, and maintaining comprehensive test scenarios, data, checklists, and other essential documentation, all aligned with specific requirements.
• Adopting best practices in software testing methodologies and techniques to guarantee optimal outcomes.
• Examine and resolve incorrect results, identify the root cause, and recommend solutions.
• Produce detailed, accurate documents in a consistent format that demonstrate strong analytical and documentation skills.
• Enhance test-based pre-production validation by effectively using post-production results and team feedback.
• Provide expert guidance and support to team members; serving as Subject matter Expert(SME)
• Effectively collaborate, coordinate and communicate across various disciplines and departments throughout the organization to resolve problems and ensure consistency and accuracy.
• Manage departmental performance to establish, meet, maintain and monitor metrics within turnaround time limits.
• Identify issues, problems, and opportunities, bring suggestions, and implement solutions to improve department's effectiveness and efficiency
• Complete and oversee special projects assigned by leadership.
• Create and distribute goals and standards to staff regularly.
• Participate in the development of policies and procedures based on current and future trends.
• Select, develop, and evaluate staff to ensure the efficient operation of department.
• Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA regulations and requirements.
• Demonstrate Company's Core Competencies and values held within.
• Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
• The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
  

Job Scope

The incumbent works independently and exercises significant independent judgment. The incumbent will manage staff and help provide thorough and appropriate responses to meet the goals of the department. The incumbent provides input to make critical business decisions, including staffing and process improvement, and impacts day-to-day operations through the oversight of coding reviews and providing direction to staff on individual cases. This is a people management job with authority for all HR actions (hiring, separations, discipline, training, etc.).

,

JOB REQUIREMENTS (Education, Experience, And Training)

• Minimum Bachelor's degree healthcare, business, or related field preferred
• Minimum 7 years' experience in the healthcare industry with a minimum of 4 years in a leadership role with people management responsibilities
• Minimum 2 years’ experience in quality assurance or testing of claim edits, claim adjudication logic, or claim platform functionality
• Experience with Project or Product Management and Agile Methodologies preferred
• Required licensures, professional certifications, and/or Board certifications as applicable - Certified by the American Health Information Management Association in coding (CCA, CCS, RHIA, RHIT) or the American Academy of Professional Coders (CPC, CPC-P, CPC-H)
• Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes)
• Knowledge of Worker's Comp, Auto Medicare and Government sponsored programs (such as Medicare or Medicaid)
• Teaching, mentoring and presentation skills and experience
• Communication (verbal, written and listening), managerial, interpersonal, organizational, time management, problem solving and leadership skills.
• Ability to analyze data and arrive at a logical conclusion
• Ability to identify issues and determine appropriate course of action for resolution
• Ability to display professionalism by having a positive demeanor, proper telephone/email etiquette and using proper language and tone.
• Ability to elicit trust and credibility with all levels of the organization
• Ability to use software and hardware related to job responsibilities, including MS Office Suite, MS SQL or Visual Studio, Team Foundation Server (TFS), online coding tools, and database software.
• Ability to work with accuracy in a fast-paced environment
• Ability to adjust/alter workflow to meet deadlines
• Ability to manage highly trained clinical coding and analytics personnel
• Ability to work collegially with health care professionals, including physicians
• Ability to work independently and handle confidential information
• Ability to process detailed verbal and written instructions
• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone
  
  

Compensation

The salary range for this position $90,000-$110,000 year. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

Benefits

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your Benefits Will Include

• Medical, dental and vision coverage with low deductible & copay
• Life insurance
• Short and long-term disability
• 401(k) + match
• Generous Paid Time Off
• Paid company holidays
• Paid Parental Leave
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program
• Summer Hours
  
  

EEO STATEMENT

MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you would like more information on your EEO rights under the law, please click here.