Healthcare Director, Front-End Clearance

Responsibilities

• Provide leadership and direction for all front-end revenue cycle functions, including referrals, authorizations, insurance verification, eligibility, coordination of benefits
• Lead and coordinate efforts between onshore and offshore teams, ensuring service quality, productivity, and adherence to SLAs
• Ensure accuracy, timeliness, and compliance across all front-end processes to minimize denials and maximize clean claim rate
• Monitor daily operations, identify bottlenecks, and implement corrective action plans as needed
• Establish standardized workflows, playbooks, and escalation paths to drive consistency and efficiency across all functions
• Partner with senior leadership to design and implement initiatives that optimize front-end operations and improve overall revenue cycle outcomes
• Leverage automation, technology, and analytics to streamline processes and reduce manual errors
• Drive continuous improvement projects focused on improving patient access, reducing turnaround times, and increasing DAR through clean claims
• Implement training and education programs for staff to maintain high levels of accuracy and compliance
• Establish, monitor, and report on KPIs, including but not limited to: Eligibility verification accuracy rate; Authorization turnaround time, Referral processing, Coordination of benefits accuracy, Clean claim rate, Denial prevention and reduction rates
• Proactively identify areas of compliance risk and develop mitigation strategies

Qualifications

• Bachelor’s degree in business or related field and/or equivalent work experience
• SHAM and/or CRCR preferred
• Leverage Six Sigma Green Belt or PMP highly desired
• 10+ years of progressive experience in Revenue Cycle Management
• 5 years in a senior leadership role overseeing front-end/pre-billing operations
• Demonstrated success managing both onshore and offshore teams, with ability to drive accountability and quality across geographies
• Strong knowledge of payer authorization policies, insurance eligibility requirements, and compliance standards
• Proven track record of improving clean claim rates, reducing denials, and optimizing front-end workflows
• Exceptional leadership, communication, and change management skills
• Strong analytical mindset with ability to leverage data for decision-making and process improvement
• Nephrology RCM experience strongly preferred
• Prior experience with Athena strongly preferred