Manager Financial Clearance

Children’s Hospital of Philadelphia•Philadelphia, PA

About The Position

Ready 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 matters You’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 gain Leadership growth while managing and mentoring a talented team Deep exposure to payor policies, contracts, and revenue cycle operations Collaboration in a mission-driven, supportive environment The opportunity to directly improve patient experience and hospital success Hands-on experience with analytics, benchmarking, and operational enhancements

Requirements

Strong healthcare financial and revenue cycle knowledge, including pricing and contracting terms
Proven people leadership and change management skills
Excellent communication, problem-solving, and organizational abilities
Comfortable in fast-paced, high-pressure environments
Data-driven mindset with strong reporting and analytics skills
Bachelor’s degree required
7+ years in revenue cycle or operations; supervisory experience preferred
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.
Demonstrates excellence in utilization of CHOP EHR.

Nice To Haves

Epic experience strongly preferred
Master’s in Business or Administration preferred
At least one (1) year Supervisory experience Preferred and
Medical Billing and Reimbursement Preferred and
Pediatric experience or experience in a healthcare setting in a customer facing environment Preferred
Pediatric experience or experience in a healthcare setting in a customer facing environment
Hospital Business Institute (HBI) Certification - Hospital Business Institute (HBI) - upon hire - Preferred

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.