Job Details

A company is looking for a Director of Clinical Operations & Coding.Key ResponsibilitiesLead coding governance and review for accuracy and compliance in molecular diagnostic testingOversee medical necessity reviews for prior authorizations and appeals, ensuring compliance with payer policiesDevelop and maintain standardized templates for prior authorizations and appeals to improve operational efficiencyRequired QualificationsBachelor's degree in Nursing, Health Sciences, Healthcare Administration, Public Health, or a related field7+ years of experience in revenue cycle, clinical operations, medical necessity review, or coding oversightExpertise in CPT and ICD-10 coding review and audit practicesProven ability to create and implement standardized documentation and operational processesStrong analytical skills with the ability to translate complex payer policies into operational guidance