MANAGER FINANCIAL CLEARANCE

General Summary/basic PURPOSE OF JOB:

The Manager Financial Clearance reflects the mission, vision and values of SHS, adheres to the organizations Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory accreditation standards.  The Manager Financial Clearance is responsible for managing the patient financial clearance functions which supports Sinai Health Systems enterprise that includes financial counseling, insurance and benefits verification, and payer authorization for outpatient, inpatient and ambulatory services for optimal performance for revenue cycle front-end process.

Reporting Relationships: 

• Reports to: System Director, Patient Access                       
• Provides Supervision to: Insurance Verification, Financial Counselors & UR Analyst

Essential Functions and duties

• Manages financial clearance functions and ensure functions are preformed efficiently, accurately and timely throughout SHS Revenue Cycle. Financial clearance functions include but are not limited to, insurance eligibility and benefit verification, regulatory requirements, health plan requirements, securing payer authorization, identifying and communicating pre-service payment requirements, and conducting financial screening when applicable.

• Maintain, update, interpret, create and enforce, when necessary, a complete record of current organizational and departmental financial policies, procedures, guidelines, workflows and training documentation.  Responsible for having complete knowledge of the patients flow and steps taken by staff to complete these procedures; assures that staff is adequately trained and meets competency requirements and levels.

• Promote a culture of performance excellence, quality and staff engagement.  Creates a culture of accountability, communication, problem solving and resource/data effective decision making, while keeping aligned with revenue cycle best practice.

• Manages appropriate staffing levels. Develop staff skills and training plans.  Ensure standard work for accurate and timely, efficient, effective and timely processing functionality throughout the enterprise, which includes maintaining an adequately trained staff to handle inpatient, outpatient and ambulatory patients.  

• Actively monitors system pre-certification/authorization denials, identifies root causes/trends and promptly implements remediation plans to prevent future denials.  Review high dollar in-patient cases and performs due diligence to ensure reimbursement and minimize financial risk.

• Develops, monitors and controls operation budgets, expenditures and expenses to avoid negative variances to achieve defined targets.

• Evaluate current staffing productivity against current volumes and propose necessary staffing changes.  Develops recruitment and retention plans consistent with the organizations HR plan.  Meet targeted goals for department specific turnover and vacancy rates. 

• Directs patients, patients’ family members and hospital staff inquiries about payer requirements, pre-authorization and payments policies. Determine best course of action for patients with high risk/complex financial situations.

• Tracks coaching discussions and actual individual and team performance to ensure accountability.  Conduct monthly staff meetings and routine staff rounding to ensure real time feedback.  Align current staff team talent and career interest with organizational opportunities. 

• Continuously examines ways to improve business relationships with customers, payers, physicians, schedulers, ancillary departments, community, ect.  Collaborates with other leaders in development, implementation and support of revenue cycle related programs/systems, which allow for consistent evaluation/treatment in relation to the requirements of the patients.

• Other duties as assigned per management.