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Children's Hospital of Philadelphia · 1 day ago

Supervisor Financial Clearance

Philadelphia, PA

Full-time

Hybrid

Senior Level

$82K/yr - $104K/yr

5+ years exp

Children’s Hospital of Philadelphia (CHOP) is seeking a Supervisor of Financial Clearance to lead a team that enhances patient care and hospital success. This role involves overseeing insurance verification, prior-authorization, and price estimation, while ensuring operational excellence and financial integrity.

Child CareHealth CareHospitalMedicalNon Profit

Growth Opportunities

Responsibilities

Lead and mentor the Financial Clearance team

Ensure timely and accurate completion of authorizations and precertification

Monitor quality and implement process improvements

Communicate pricing and insurance details with professionalism and empathy

Partner with Epic teams to troubleshoot system delays and remain informed on upcoming updates and enhancements

Acts as internal expert on the use, interpretation and accurate application of Epic Tool as used for developing patient cost estimates

Assists in revenue maximization through ensuring quality and standardization in both the front-end and back-end processes related to patient cost estimates

Influence a family's decision to choose CHOP as their child's care provider through educated, informed, and accurate patient cost estimates tied to CHOP quality and value

Replies to inquiries for financial clearance support, price estimates and ensures that accurate preparation of estimates based on anticipated services and type of estimate requested (i.e. charges, reimbursement, patient responsibility, etc.)

Accepts payments made in advance of service and hands off to appropriate billing office for posting to patient account

Ensures all activities are documented within Epic

Develops methods to maintain or improve Financial Clearance team performance in accordance with organizational standards

Develops, monitors, and assesses business metrics in order to refine processes and improve efficiencies

Contributes to optimum performance through management, oversight, and continuous improvement of the daily operations to achieve key performance targets

Supervisor must anticipate and respond effectively to evolving market and environmental trends, (e.g., shifts in payment models, value based purchasing, transparency of outcomes and information technology)

Maintains sound working knowledge of current industry best practice concepts and practices, and is responsible for the integration and adoption of best practice processes

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 at a lower cost

Establishes positive and highly communicative relationships with all leadership personnel, with the intent purpose of serving as a liaison, providing an unbiased perspective in identification of workflow challenges and solution process

Routinely communicates the department's performance with staff and solicits their feedback regarding workflow and enhancements to the estimation process

Supervises operational staff responsible for financial clearance spanning authorizations to patient estimations:

Handles staff feedback regarding job performance

Meets with each staff member 'one-on-one' regularly

Conducts monthly department staff meetings and in-services as needed

Completes all written performance appraisals in a comprehensive and timely manner

Identifies potential deficiencies and works in a proactive approach to resolve issues

Completes any performance improvement plans necessary for staff development

Recognize excellent achievements among staff

Ensures timely completion of authorizations in accordance with the payer's policies and contract guidelines. Ensures accounts are updated appropriately

Ensures adequate staff coverage for Precert Team; coordinates work load with time off requests

Establishes written policies and procedures governing operational workflow

Obtains denial information relevant to the appeals process and lead necessary action to complete appeals process

Remains updated on network and contract rates regularly, reports changes to management and applicable staff

Partners with Epic teams to identify system delays and partners for system updates

Qualification

Healthcare financial operationsMedical billingReimbursementEPIC experienceData analyticsLeadership experienceCustomer service skillsCoding rulesContracting terms knowledgeCRCR certificationEPIC trainer certificationCommunicationProblem-solving skillsOrganizational skillsProject managementCollaboration skillsInterpersonal skills

Required

High School Diploma / GED Required

At least five (5) years experience in Financial Counseling, Revenue Cycle or Operations Required

Deep knowledge of healthcare financial operations, including medical billing and reimbursement, coding guidelines, contract terms, and insurance benefits

Proven leadership experience; with the ability to implement change in a positive, and forward-thinking manner

Excellent communication (both written and verbal) and problem-solving skills

Passion for teamwork and continuous improvement

Ability to operate in high-pressure situations

Effective organizational, planning, and project management skills

Skilled in leveraging reporting and data analytics to optimize operations and inform strategic decisions

Strong EPIC experience navigating orders, clinical documentation and authorization fields preferred

Preferred

Bachelor's Degree Preferred

Supervisory experience Preferred

Experience with Medical Billing and Reimbursement preferred

Experience in a healthcare setting in a customer facing environment, preferred

Demonstrates excellence in utilization of CHOP EHR

Working knowledge of coding rules required preferred

Certified Revenue Cycle Representative (CRCR) - Healthcare Financial Management Association - - Preferred

EPIC certification - Trainer Certification - - Preferred

Benefits

Healthcare Financial Management Association (HFMA) Membership & benefits

This job is eligible for an incentive program.

Company

Children's Hospital of Philadelphia

Glassdoor4.0

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.

Founded in 1855

Philadelphia, Pennsylvania, USA

10001+ employees