Manager Financial Clearance

SHIFT:Day (United States of America)Seeking Breakthrough Makers Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation. At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care—and your career. CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means. A Brief OverviewReady to take the next step in your career and lead work that truly impacts patient care?We’re looking for a Manager of Financial Clearance to lead a high-performing team that ensures patients and families can access CHOP care with confidence in both quality and cost.Why this role mattersYou’ll oversee insurance verification, prior authorizations, price estimates, and medical necessity validation—partnering with leadership, payors, and Epic teams to reduce denials, improve workflows, and support CHOP’s financial sustainability. You’ll also ensure compliance with price transparency regulations, manage administrative denials, and optimize reimbursement strategies.What you’ll gainLeadership growth while managing and mentoring a talented teamDeep exposure to payor policies, contracts, and revenue cycle operationsCollaboration in a mission-driven, supportive environmentThe opportunity to directly improve patient experience and hospital successHands-on experience with analytics, benchmarking, and operational enhancementsKey responsibilitiesLead and develop the Financial Clearance team, including staffing and trainingEnsure timely, accurate authorizations and precertificationsDrive quality monitoring and process improvement using data analyticsPartner with Epic and Revenue Cycle teams on system issues and enhancementsMaintain compliance with price transparency requirements and develop strategies for competitive pricingCollaborate with Managed Care on contracting and reimbursement scenariosIdeal candidateStrong healthcare financial and revenue cycle knowledge, including pricing and contracting termsProven people leadership and change management skillsExcellent communication, problem-solving, and organizational abilitiesComfortable in fast-paced, high-pressure environmentsData-driven mindset with strong reporting and analytics skillsEpic experience strongly preferredBachelor’s degree required; Master’s in Business or Administration preferred7+ years in revenue cycle or operations; supervisory experience preferredWhat you will doOversight 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 workflowsSupports enterprise wide financial clearance processes and workflows from benefit verification through authorizationsMonitors 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 divisionsMaintains 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.Education QualificationsBachelor's Degree RequiredMaster's Degree Administration or Business PreferredExperience Qua