Children's Hospital of Philadelphia · 4 weeks ago
Manager Financial Clearance
Philadelphia, PA
Full-time
Onsite
Mid, Senior Level
$105K/yr - $139K/yr
7+ years expChildren’s Hospital of Philadelphia (CHOP) offers countless ways to change lives, and they are seeking a Manager of Financial Clearance to lead a high-performing team. The role involves overseeing insurance verification, prior authorizations, and ensuring compliance with financial regulations to support the hospital’s financial sustainability.
Child CareHealth CareHospitalMedicalNon Profit
Responsibilities
Lead and develop the Financial Clearance team, including staffing and training
Ensure timely, accurate authorizations and precertifications
Drive quality monitoring and process improvement using data analytics
Partner with Epic and Revenue Cycle teams on system issues and enhancements
Maintain compliance with price transparency requirements and develop strategies for competitive pricing
Collaborate with Managed Care on contracting and reimbursement scenarios
Oversight and implementation of Financial Clearance team, including staffing operational processes, developing annual and multi-year work plans and strategies, ensuring resources are available to achieve work plans, resolving complex business issues, and establishing management practices
Works closely with organizational leaders to implement new processes and training while maintaining productivity and minimizing disruption financial clearance workflows
Supports enterprise wide financial clearance processes and workflows from benefit verification through authorizations
Monitors facility progress based on performance benchmarks and addresses issues as they arise; identifies and quantifies mid-cycle revenue leakage and works with facility leadership to implement solutions
Participates with Corporate Managed Care to review contracting relationships, operational impediments, and reimbursement scenario analysis connected with relative coverage areas
Financially secure patient care prior to or at time of care, avoid bad debt related to inaccurate patient cost estimates as a result of incorrect patient payer or demographic data, and enhance patient/family and physician/provider satisfaction with patient cost estimation processes
Monitors metrics and develops performance improvement plans to improve patient and provider/staff interactions and experiences
Provides on-going communication and partnership with Revenue Cycle departments and all divisions
Maintains sound working knowledge of current industry best practice concepts and practices, and is responsible for the integration and adoption of best practice processes. Develops written policies and procedures based on best practices within the industry
Proactively identifies and resolves operational and system problems or issues
Recommends enhancements to the current workflow that will help to streamline the operation and provide greater service to customers
Qualification
Required
Bachelor's Degree Required
At least seven (7) years experience in customer service, revenue cycle or operations with a working knowledge of coding rules. Required
Requires in depth understanding of pricing and contracting terms, including managed care business processes, enrollment, and benefit design. (Required proficiency)
Demonstrates excellence in utilization of CHOP EHR. (Required proficiency)
Preferred
Epic experience strongly preferred
Master's in Business or Administration preferred
At least one (1) year Supervisory experience Preferred
Medical Billing and Reimbursement Preferred
Pediatric experience or experience in a healthcare setting in a customer facing environment Preferred
Hospital Business Institute (HBI) Certification - Hospital Business Institute (HBI) - upon hire - Preferred
Benefits
This job is eligible for an incentive program.
At CHOP, we are committed to fair and transparent pay practices.
Company
Children's Hospital of Philadelphia
Since its start in 1855 as the nation's first hospital devoted exclusively to caring for children, The Children's Hospital of Philadelphia has been the birthplace for many dramatic firsts in pediatric medicine.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$33.35MKey Investors
UnitedHealthcare Community PlanNational Cancer InstituteBill & Melinda Gates Foundation
2025-12-10Grant· $1.7M
2025-09-29Grant· $1M
2025-06-18Grant· $1M
Leadership Team
Ron Keren
Senior Vice President and Chief Medical Officer
Adam Resnick
Director of the Center for Data Driven Discovery in Biomedicine (D3b)
Recent News
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