Supervisor Financial Clearance

Children's Hospital of Philadelphia

3d•$83,700 - $106,700•Hybrid

About The Position

Seeking a Supervisor of Financial Clearance to join a dynamic team. This role ensures patients and families have access to CHOP providers and treatments with confidence in both quality and cost, while driving operational excellence and financial integrity. The supervisor will oversee a team responsible for insurance verification, prior-authorization, price estimation, and medical necessity validation. They will partner with leadership and payors to streamline authorizations, prevent administrative denials, and maximize reimbursement, helping CHOP deliver exceptional care while maintaining financial sustainability.

Requirements

High School Diploma / GED Required
At least five (5) years experience in Financial Counseling, Revenue Cycle or Operations Required
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.

Nice To Haves

Bachelor's Degree Preferred
Supervisory experience Preferred
Strong EPIC experience navigating orders, clinical documentation and authorization fields preferred.
Certified Revenue Cycle Representative (CRCR) - Healthcare Financial Management Association - - Preferred
EPIC certification - Trainer Certification - - Preferred

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