AVP Financial Clearance and Utilization Management

SHIFT:

Day (United States of America)

Seeking Breakthrough Makers
Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.
At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care—and your career.
CHOP’s Commitment to Diversity, Equity, and Inclusion
CHOP is committed to building an inclusive culture where employees feel a sense of belonging, connection, and community within their workplace. We are a team dedicated to fostering an environment that allows for all to be their authentic selves. We are focused on attracting, cultivating, and retaining diverse talent who can help us deliver on our mission to be a world leader in the advancement of healthcare for children.
We strongly encourage all candidates of diverse backgrounds and lived experiences to apply.

A Brief Overview
The AVP of Financial Clearance and Utilization Management is responsible for overseeing and managing an organization's financial clearance, utilization management and coordinate with scheduling & registration on end-to-end processes. This role requires a deep understanding of healthcare finance, revenue cycle management, financial clearance, registration, and utilization management principles. The AVP of Financial Clearance and Utilization Management is responsible for developing and implementing strategies to optimize the organization's financial performance and ensure timely reimbursement for services rendered. They collaborate with various departments, including billing, coding, case/care management, scheduling, registration, and revenue cycle leaders across the enterprise, to streamline processes and improve financial outcomes.

What you will do

• Financial Clearance: Oversight, continue to develop and implement policies and procedures for verifying patient insurance coverage, obtaining pre-authorization for services, and ensuring accurate and timely billing.
• Utilization Management: Oversight, working closely with the clinical team to continue to develop and implement utilization management protocols and guidelines to ensure appropriate and cost-effective use of healthcare resources.
• Registration Coordination: Work closely with our registration and scheduling leaders to engage on process improvement activities to support reduction of denials and reduction of re-work.
• Revenue Cycle Management: Coordinating revenue cycle processes, including billing, claims management, denials management, collections and customer service, to maximize reimbursement and minimize revenue leakage.
• Performance Monitoring: Establishing key performance indicators (KPIs) and monitoring financial and operational metrics to identify areas for improvement and drive performance.
• Compliance and Regulatory Compliance: Ensuring compliance with relevant healthcare regulations, such as HIPAA, CMS guidelines, and payer requirements, to minimize risk and avoid penalties.
• Staff Leadership and Development: Providing leadership and guidance to the financial clearance and utilization management teams, including hiring, training, and performance management.
• Technology and Process Improvement: Identifying opportunities for process automation and technology implementation to improve efficiency, accuracy, and overall financial performance.
• Collaboration and Communication: Collaborating with internal and external stakeholders, including physicians, payers and vendors, to optimize financial outcomes and resolve issues.
• Overall, the AVP of Financial Clearance and Utilization Management plays a critical role in ensuring the organization's financial viability by optimizing revenue cycle performance and effectively managing healthcare utilization.

Education Qualifications

• Bachelor's Degree Business, Health Care Administration or related field of study Required
• Master's Degree Business, Health Care Administration or related field of study Preferred

Experience Qualifications

• At least eight (8) years Related experience in a hospital or health care related environment Required
• At least five (5) years Leadership experience in a academic medical center, consulting, or large health system environment Required

Skills and Abilities

• Require leadership qualities; consensus builder able to work both independently and collaboratively. (Required proficiency)
• Project management skills. (Required proficiency)
• Action-oriented; proven track record of achieving agreed-upon goals. (Required proficiency)
<