Director Financial Operations Department - CarelonRx Revenue Cycle Management

Elevance Health • Nashville, FL

3d • Hybrid

About The Position

Director Financial Operations Department - CarelonRx Revenue Cycle Management Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member’s health. The Director Financial Operations Department coordinates, directs and manages operational areas of Finance. Leads and participates in committees and projects that are enterprise-wide in scope. will act as project sponsor. How you will make an impact: Counsels senior management on enterprise-wide policies and strategies. Represents the company in legal matters and testifies as needed. Develops and implements vision, strategies, and tactics to maximize the department's effectiveness while minimizing costs. Ensures internal controls are appropriate and develops policies and procedures and ensures compliance with government regulations. Works with other areas for solutions to complex problems and participates in critical interactions with both internal and external customers. Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Requirements

• Requires a minimum of 8 years experience with operations, financial reporting and analysis, audit guidelines, budgeting and multi-state operations and processes and a minimum of 5 years management experience; or any combination of education and experience which would provide an equivalent background.

Nice To Haves

• Prior leadership experience, including coaching, workflow oversight, training, or team lead responsibilities in a healthcare or claims environment.
• Background in specialty pharmacy and infusion therapy operations (e.g., benefit verification, prior authorizations, coordination of care, site-of-care support).
• Working knowledge of Major Medical and PBM claim adjudication, including medical vs. pharmacy benefit distinctions and payer processing nuances.
• Experience supporting Medicare and Medicaid members, including familiarity with coverage requirements and payer-specific processes.
• Strong understanding of medical billing terminology, payer systems, and claim adjudication processes.
• Proficiency in RCM software systems and Microsoft Office Suite (especially Excel).
• Excellent analytical, organizational, and communication skills.
• Ability to prepare detailed reports, track financial performance, and present findings to executive leadership.
• Experience with complex business environments including multiple entity and highly automated situations strongly preferred.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees