Clinical Operations Manager

Clinical Operations Manager

At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

JOB SUMMARY
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.

DUTIES

• 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.

COMPENSATION
The salary range for this position is $100,000 – $120,000. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

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 acc