Clinical Validation AVP
Company: VirtualVocations
Location: Saginaw
Posted on: October 29, 2024
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Job Description:
A company is looking for an AVP, Clinical Validation (PI) to
lead the Clinical Operations team in payment integrity
initiatives.
Key Responsibilities
Lead the Clinical Operations team for Pre-pay and Post-pay DRG
validation and medical record reviews
Develop and refine clinical policies and optimize content to
minimize dispute overturn rates
Analyze dispute data to identify trends and drive cost-saving
opportunities in collaboration with various teams
Required Qualifications
Bachelor's Degree in Healthcare Administration, Health Information
Management, or relevant experience
Minimum of 7 years of healthcare experience, including 5+ years in
managed care payor settings
Rich understanding of ICD-9/10CM and DRG reimbursement
methodologies
5+ years of leadership experience managing a team or department
Preferred Master's Degree and relevant coding certifications (CCS,
CIC, CDIP, or CCDS)
Keywords: VirtualVocations, Roseville , Clinical Validation AVP, Healthcare , Saginaw, Michigan
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