Supervisor Financial Clearance

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A Brief Overview
Supervisor of Financial clearance will ensure patients, families, or referring clinicians are able to identify CHOP providers, therapies, or treatments that offer the desired combination of price and quality. Supervisor of Financial Clearance partners with leadership and other internal and external customers to ensure timely completion of authorizations and to ensure effectiveness of the precertification / authorization process. Oversee processes to aid in proper reimbursement and manage administrative denials in accordance with payor contracts and maximize the financial reimbursement for the hospital. This position is responsible for overseeing the financial clearance team including insurance verification, price estimation, and validation of medical necessity for certain services. This individual will have extensive knowledge of the organization's charge masters, contract terms, payor policies for authorization and precertification of services and an ability to communicate information surrounding price estimates by service, including applicable discounts, in a professional and polite atmosphere. Is responsible for the daily oversight of the Financial Clearance staff and the functions they perform. The Supervisor must have a daily pulse on the volume of incoming work, current staffing levels and department objectives. The Supervisor plays an integral role in monitoring the quality of work performed within the department, and developing process improvements as needed.

What you will do

• Acts as internal expert on the use, interpretation and accurate application of Epic Tool as used for developing patient cost estimates.
• 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 of patient cost estimation team 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) that will impact the delivery of 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.
• 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.
• 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.
• 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' monthly.
• 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.
• Routinely communicates the department's performance with staff and solicits their feedback regarding workflow and enhancements to the estimation process.
• 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
• 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.)
• Remains updated on network and contract rates regularly, reports changes to management and applicable staff.
• Establishes written policies and procedures governing operational workflow.
• Obtains denial information relevant to the appeals process and lead necessary action to complete appeals process.
• 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.
• Identifies system interface delays; prepares specifications for system improvements and work with Information Systems, Sr. Systems Analysts, and other pertinent parties to resolve problems.
• 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.

Education Qualifications

• High School Diploma / GED - Required
• Bachelor's Degree - Preferred

Experience Qualifications

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

Skills and Abilities

• Strong teamwork skills
• Excellent organizational, project management, interpersonal, leadership and customer service skills
• Displays in-depth understanding of contracting terms, including managed care business processes, enrollment, and benefit design.
• 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.

Licenses and Certifications

• Certified Revenue Cycle Representative (CRCR) - Healthcare Financial Management Association - upon hire - Preferred
• EPIC certification - Trainer Certification - upon hire - Preferred

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, professionals working onsite—at any CHOP location, for any portion of time—must be vaccinated for COVID-19. Learn more.

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