AVP Financial Clearance and Utilization Management

SHIFT:

• 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.

• 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

• 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

• 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)
• Skilled communicator with a style that engenders trust and accountability. (Required proficiency)
• Excellent customer service skills relating to internal and external customers, departments and facilities, associates and physicians, various committees, vendors, and governmental agencies. (Required proficiency)
• Facilitator with excellent presentation skills. (Required proficiency)
• Energetic with a collaborative style. (Required proficiency)
• Thinks proactively and strategically with sound business and planning skills. (Required proficiency)
• Ability to effectively move through complex political situations. (Required proficiency)
• Emphasizes team goals with a common purpose and seeks win-win solutions. (Required proficiency)
• Takes ownership of projects, programs, and services and accepts accountability for results. (Required proficiency)
• In-depth knowledge of third-party requirements, Medicare/Medicaid regulations, and electronic claims filing. (Required proficiency)
• Understanding of components of electronic medical records. (Required proficiency)
• Solid working knowledge of process innovation methodology. (Required proficiency)
• Knowledge of revenue cycle processes, hospital/ medical billing, registration/financial clearance, or utilization management. (Required proficiency)

• Certified Revenue Cycle Representative (CRCR) - Healthcare Financial Management Association (HFMA) - upon hire - Preferred
• Hospital Business Institute (HBI) Certification - Healthcare Business International - upon hire - Preferred
• Certified Health Financial Professional (CHFP) - Healthcare Financial Management Association (HFMA) - upon hire - Preferred
• Certified Public Accountant (CPA) - Pennsylvania State Licensing Board - upon hire - Preferred
• Registered Health Information Technician (RHIT) - American Health Information Management Association - upon hire - Preferred