California Licensed Specialty Director

Job Summary

A company is looking for a Director of Specialty Solutions.

Key Responsibilities

• Oversee outpatient claim review operations and develop review protocols in alignment with regulatory and client requirements
• Mentor and manage review staff to foster a culture of accountability and continuous improvement
• Ensure quality assurance and compliance with internal and client standards for specialty outpatient reviews

Required Qualifications

• Bachelor's degree in Health Information Management, Business, Nursing, or related field (Master's preferred)
• Minimum 7 years of healthcare claims reviewing experience, with at least 3 years in a production management role
• Expertise in APC, outpatient coding (CPT, HCPCS, ICD-10), and hospital billing
• Proficiency with review and billing software, data analysis, and Microsoft Office
• Advanced knowledge of payer review requirements and regulatory standards