Director-Financial Clearance

Cincinnati Children's•Andrews, IN

1d•$100,526 - $130,686•Onsite

About The Position

This role oversees billing and receivables across different areas of the hospital, ensuring effective coordination between billing, authorization, and payer relations to support timely reimbursement and an optimal patient experience. The Director-Financial Clearance will be responsible for optimizing the revenue cycle, ensuring complete and accurate physician hospital and/or home health billing and compliant coding, monitoring associated charge capture, developing/expanding programs, effective denial management, and monthly revenue reporting. They will also oversee insurance verification and authorization processes to ensure timely approvals for services, procedures, and medications, and partner with clinical and billing teams to reduce authorization-related denials and delays in reimbursement. The role involves proposing, researching, and managing the development, implementation, and assessment of long and short-term operating goals and objectives, operationalizing, implementing, and monitoring assigned strategic initiatives, and driving the execution of assigned strategic plan components. Project management responsibilities include providing leadership for the overall direction, coordination, implementation, execution, control, and completion of specific projects, defining project scope, goals, deliverables, and resource requirements, and managing project budgets and timelines. Performance management includes directing the development and monitoring of an effective staffing and retention strategy, including hiring and terminating employees, workforce planning, succession planning, and ensuring staff are trained and proficient in insurance authorization, payer requirements, and denial prevention strategies. Financial management responsibilities include overall accountability for the financial management functions for the department, developing and managing the department's annual and capital budget, establishing internal controls for cash management, and implementing and maintaining a process for financial controls and external financial audits. The role also involves developing and implementing accounts receivable management, analyzing and monitoring financial performance, and evaluating variances to identify and implement corrective actions. The Director will also analyze the financial impact of authorization trends, including denial rates and approval turnaround times, and implement corrective actions.

Requirements

Bachelor's degree in a related field
7+ years of work experience in a related job discipline

Responsibilities

Optimize revenue, ensure complete and accurate physician hospital and/or home health billing and compliant coding, monitoring associated charge capture; developing/expanding programs; effective denial management; and monthly revenue reporting.
Oversee insurance verification and authorization processes to ensure timely approvals for services, procedures, and medications.
Partner with clinical and billing teams to reduce authorization-related denials and delays in reimbursement.
Monitor payer requirements and ensure compliance with prior authorization guidelines and documentation standards.
Propose, research, and manage the development, implementation and assessment of long and short term operating goals and objectives.
Operationalize, implement and monitor assigned strategic initiatives.
Drive execution of the assigned strategic plan components.
Lead process improvements related to authorization workflows to improve turnaround time and patient access.
Collaborate across departments to ensure alignment between authorization, scheduling, and revenue cycle functions.
Provide leadership for the overall direction, coordination, implementation, execution, control and completion of specific projects ensuring consistency with organizational strategy, commitments and goals.
Define project scope, goals, deliverables and resource requirements.
Define and manage the project budget.
Develop project plans, resource allocation, and timeline.
Manage the day-to-day operational aspects of a project and scope.
Direct assigned project team ensuring effective utilization of resources.
Monitor project deliverables and report on progress of the project to all stakeholders.
Lead projects focused on improving insurance authorization processes, automation, and payer communication strategies.
Direct the development and monitoring of an effective staffing and retention strategy, including hiring and terminating employees, workforce planning, succession planning; attracting and retaining top performers, partnering with leadership and Human Resources to develop effective and appropriate recruitment packages, and effective on-boarding programs for staff; effective performance management of direct reports; in partnership with leadership, provide mentoring and development to faculty and other leaders in effective performance management; mentor and provide learning and development opportunities for direct reports and others in business roles; effectively and appropriately leveraging human resources business partners to meet the division's talent management goals; ultimate responsibility for supporting organizational programs/plans that impact employees and ensuring communication, comprehension, and adherence to all Human Resources policies and related legal and/or compliance requirements.
Ensure staff are trained and proficient in insurance authorization, payer requirements, and denial prevention strategies.
Overall accountability for the financial management functions for the department.
Develop, implement, evaluate and manage the department's annual and capital budget to achieve the Divisional and Departmental objectives; establish internal controls for cash management; implement and maintain a process for financial controls and external financial audits; develop and implement accounts receivable management; analyze and monitor financial performance and report financial results to stakeholders; evaluate variances, determine underlying causes and identify, present, and implement proposed solutions; establish and monitor productivity metrics; ultimate accountability for compliance with organizational financial policies and procedures.
Analyze financial impact of authorization trends, including denial rates and approval turnaround times, and implement corrective actions.
Oversees billing and receivables across different areas of the hospital.
Ensures effective coordination between billing, authorization, and payer relations to support timely reimbursement and optimal patient experience.