Clinical Operations Manager

Claritev•New York, NY

2d•$100,000 - $120,000

About The Position

The Clinical Operations Manager is responsible for leading and managing clinical operations staff, ensuring accurate and timely review of complex claims by applying clinical knowledge, coding standards, industry expertise, and federal regulations. This role oversees daily operations, supports quality and compliance initiatives, and drives performance to meet client expectations and service level agreements. The incumbent will also provide guidance, training, and mentorship to clinical staff while supporting process improvements and operational efficiencies.

Requirements

Minimum high school diploma. Bachelor's degree in healthcare, business, or related field preferred. International education or training is a plus.
Minimum 7 years' experience in a clinically related field including but not limited to: complex hospital and medical billing procedures and coding, auditing, nursing, radiology, laboratory, pharmacy, or a physician assistant position.
Minimum 4 years' leadership role with people management responsibilities, including managing remote or international teams.
Current coding certification by the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) or medical license (RN, MD). International certifications or licensure are advantageous.
Extensive knowledge of inpatient/outpatient hospital billing and claims data including UB-04s, revenue codes, itemization of charges, CPT codes, HCPCS codes, ICD-10 diagnoses and procedure codes, DRG, APCs, including international coding systems (e.g., KSA, ICD-10-AM, SNOMED).
Knowledge of Workers' Compensation, Auto, Medicare and government-sponsored programs (such as Medicare or Medicaid).
Knowledge of provider billing and collection practices and international payer systems.
Teaching, mentoring and presentation skills and experience.
Strong communication, managerial, interpersonal, organizational, time management, problem-solving, and leadership skills, with cross-cultural competence.
Ability to commit to providing a level of customer service within established standards.
Ability to analyze data and arrive at a logical conclusion.
Ability to identify issues and determine appropriate course of action for resolution.
Professional demeanor, proper etiquette, and cultural sensitivity in all communications.
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, 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 nursing personnel.
Ability to work collegially with healthcare 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.

Responsibilities

Leads, manages, and develops clinical operations staff, including coding and nursing personnel.
Oversees the review and analysis of complex claims to ensure accuracy, compliance, and adherence to billing standards.
Monitors team performance to ensure productivity, quality, and service level agreements (SLAs) are met.
Provides coaching, training, and mentorship to team members to support development and performance improvement.
Partners with leadership to identify process improvements and implement operational efficiencies.
Ensures compliance with federal regulations, coding standards, and internal policies.
Reviews and analyzes data to identify trends, issues, and opportunities for improvement.
Collaborates with cross-functional teams and stakeholders to support operational goals and client needs.
Supports audits, reporting, and escalation management as needed.
Maintains a high level of customer service and professionalism in all interactions.

Benefits

Medical, dental and vision coverage with low deductible & copay
Life insurance
Short and long-term disability
Paid Parental Leave
401(k) + match
Employee Stock Purchase Plan
Generous Paid Time Off – accrued based on years of service
WA Candidates: the accrual rate is 4.61 hours every other week for the first two years of tenure before increasing with additional years of service
10 paid company holidays
Tuition reimbursement
Flexible Spending Account
Employee Assistance Program
Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year, unless the laws of the state in which the employee is located provide for more generous sick time benefits