Revenue Cycle Clinical Director

About the role

Working at Moffitt is both a career and a mission: to contribute to the prevention and cure of cancer. As the only National Cancer Institute-designated Comprehensive Cancer Center based in Florida, Moffitt employs some of the best and brightest minds from around the world. Join a dedicated team of nearly 11,000 who are shaping the future we envision. Moffitt has been recognized as a Best and Brightest Company to Work For in the Nation and is continually named one of the Tampa Bay Times’ Top Workplaces.

The Revenue Cycle Medical Director performs all aspects of the Peer to Peer Review Program, financial clearance and medical necessity check. Communicates with clinical counterparts at the payor and within the cancer center. Organizes and prioritizes encounters needing financial clearance due to pending Peer to Peer reviews to ensure timely patient care and secure reimbursement. This position is responsible for performing all peer to peer conversations for medically necessary services on behalf of ordering providers as well as providing feedback and education to physicians on upheld denials. Works directly with insurance companies (payors) using clinical expertise to obtain authorizations and overturn pre-service denials. Reduces/minimizes the need to escalate cases to Moffitt physicians. Performs clinical review of medical records to determine if documentation is sufficient and contacts payor directly or reaches out to ordering physician and/or clinical team to obtain additional information for the case prior to contacting payor to overturn the denial. Maintains a deep knowledge of payor classifications, rules and criteria for authorizations and peer to peer process. Educates and advises providers and their clinical teams, Nursing team, payer strategies, pharmacy and Financial Clearance unit team.

Responsibilities

• Perform peer‑to‑peer conversations for medically necessary services on behalf of ordering providers.
• Provide feedback and education to physicians on upheld denials.
• Work directly with insurance companies (payors) using clinical expertise to obtain authorizations and overturn pre‑service denials.
• Reduce/minimize the need to escalate cases to Moffitt physicians.
• Perform