Director, Centralized Financial Clearance and Price Estimates (Director, Revenue Cycle)

Department Overview

The Director of Centralized Financial Clearance and Prices Estimates is responsible for the strategic and operational oversight of financial clearance, price estimates, and referral workflows across OHSU Health and has direct management responsibility for the Centralized Financial Clearance, Insurance Verification Specialists, Price Estimates, and Epic Referrals Systems teams that support various departments and services across the OHSU Health system. Financial Clearance workflows include verifying insurance coverage and benefits, submitting and obtaining prior authorizations, and providing price transparency for patients who are self-pay, are receiving non-covered services, or have an insurance that is out of network and/or non-contracted. In addition, the Centralized Finanical Clearance team ensures that all planned admissions to the OHSU hospital and urgent admits (ED or add-ons) have the appropriate benefits, are authorized, and ensure payor notifications are completed at the time of admission. This position also has direct oversight of the Epic Referrals Systems team, which manages the referral application workflows and system build within Epic, as well as all associated projects. 

 

The Centralized Finanical Clearance team currently supports 34 departments, and the goal is to continue to centralize the remaining roughly 40 decentralized departments over time. This position will be responsible for setting the strategic direction for these centralization efforts and partnering with the decentralized departments to progress centralization over time.

Function/Duties of Position

This position is responsible for maintaining and developing key performance indicators and for transparent reporting at the organizational and departmental levels to ensure the department consistently meets service level agreements. As it relates to key performance indicators, this position will be responsible for improving price estimate accuracy, increasing price transparency, ensuring authorizations are submitted and received within best-practice benchmarks, and reducing no-authorization denials. If performance gaps exist, this position will be expected to lead process improvement initiatives with key stakeholders across the OHSU Health system to get the team back on track. This includes ongoing monthly investigation of front-end no-auth denials to identify trends and improve workflows.

 

The Director sets the strategic direction and works to align and standardize Financial Clearance and Price Estimate Epic workflows, operational workflows, training, and metrics across OHSU (for both centralized and non-centralized teams) and OHSU Health partner organizations, both current and future. This position will also keep apprised of and recommend best practices and emerging technologies to automate and improve processes.

 

Personnel Management

• Complete supervision of the Centralized Financial Clearance and Referral Systems teams, which supports departments and services across OHSU Health, including interviewing, hiring, training and orientation, work assignments, staffing, performance monitoring, ongoing feedback, counseling, disciplinary procedures up to and including dismissal, and responding to grievances.
• Develops appropriate staffing plans to ensure team performance is achieved.
• Assures key performance indicators and quality and accountability measures are in place to ensure team success.
• Maintains a strong leadership team for Patient Access Services, including managers and supervisors. 

Operations Management

• Standardizes financial clearance, insurance verification, and price estimate workflows across OHSU Health.
• Measures quality indicators to ensure that staff provide high-quality customer service to both external and internal customers. 
• Measures for staff include accuracy and volume of work performed, prompt and professional communication, face-to-face customer contact skills, appropriate problem-solving, ability to learn and use available information technology, standard complaint processing, positive and respectful peer communication, and relationship skills in providing coverage for the department's internal service needs.

Strategic Planning and Execution

• Provides strategic planning and direction for financial clearance and price estimates across OHSU Health.
• Maintains current knowledge of industry best practice workflows and metrics to identify gaps in performance. Utilizes the gaps to always have a 1-2 year plan on how to improve efficiencies and consistently meets and exceeds best practice benchmarks.
• In addition, develops and executes the strategic direction and approach for centralizing financial clearance activities across OHSU.