Manager Financial Clearance

SHIFT:

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 does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.


A Brief Overview

Ready to take the next step in your career and lead work that truly impacts patient care?

We’re looking for a Manager of Financial Clearance to lead a high-performing team that ensures patients and families can access CHOP care with confidence in both quality and cost.

Why this role matters

You’ll oversee insurance verification, prior authorizations, price estimates, and medical necessity validation—partnering with leadership, payors, and Epic teams to reduce denials, improve workflows, and support CHOP’s financial sustainability. You’ll also ensure compliance with price transparency regulations, manage administrative denials, and optimize reimbursement strategies.

What you’ll gain

• Leadership growth while managing and mentoring a talented team
• Deep exposure to payor policies, contracts, and revenue cycle operations
• Collaboration in a mission-driven, supportive environment
• The opportunity to directly improve patient experience and hospital success
• Hands-on experience with analytics, benchmarking, and operational enhancements

Key responsibilities

• Lead and develop the Financial Clearance team, including staffing and training
• Ensure timely, accurate authorizations and precertifications
• Drive quality monitoring and process improvement using data analytics
• Partner with Epic and Revenue Cycle teams on system issues and enhancements
• Maintain compliance with price transparency requirements and develop strategies for competitive pricing
• Collaborate with Managed Care on contracting and reimbursement scenarios

Ideal candidate

• Strong healthcare financial and revenue cycle knowledge, including pricing and contracting terms
• Proven people leadership and change management skills
• Excellent communication, problem-solving, and organizational abilities
• Comfortable in fast-paced, high-pressure environments
• Data-driven mindset with strong reporting and analytics skills
• Epic experience strongly preferred
• Bachelor’s degree required; Master’s in Business or Administration preferred
• 7+ years in revenue cycle or operations; supervisory experience preferred

What you will do

• Oversight and implementation of Financial Clearance team, including staffing operational processes, developing annual and multi-year work plans and strategies, ensuring resources are available to achieve work plans, resolving complex business issues, and establishing management practices.
• Works closely with organizational leaders to implement new processes and training while maintaining productivity and minimizing disruption financial clearance workflows
• Supports enterprise wide financial clearance processes and workflows from benefit verification through authorizations
• Monitors facility progress based on performance benchmarks and addresses issues as they arise; identifies and quantifies mid-cycle revenue leakage and works with facility leadership to implement solutions.
• Participates with Corporate Managed Care to review contracting relationships, operational impediments, and reimbursement scenario analysis connected with relative coverage areas.
• Financially secure patient care prior to or at time of care, avoid bad debt related to inaccurate patient cost estimates as a result of incorrect patient payer or demographic data, and enhance patient/family and physician/provider satisfaction with patient cost estimation processes.
• Monitors metrics and develops performance improvement plans to improve patient and provider/staff interactions and experiences.
• Provides on-going communication and partnership with Revenue Cycle departments and all divisions
• Maintains sound working knowledge of current industry best practice concepts and practices, and is responsible for the integration and adoption of best practice processes. Develops written policies and procedures based on best practices within the industry.
• 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 to customers.

Education Qualifications

• Bachelor's Degree Required
• Master's Degree Administration or Business Preferred

Experience Qualifications

• At least seven (7) years experience in customer service, revenue cycle or operations with a working knowledge of coding rules. Required
• At least one (1) year Supervisory experience Preferred and
• Medical Billing and Reimbursement Preferred and
• Pediatric experience or experience in a healthcare setting in a customer facing environment Preferred

Skills and Abilities

• Requires in depth understanding of pricing and contracting terms, including managed care business processes, enrollment, and benefit design. (Required proficiency)
• Demonstrates excellence in utilization of CHOP EHR. (Required proficiency)
• Pediatric experience or experience in a healthcare setting in a customer facing environment (Preferred proficiency)

Licenses and Certifications

• Hospital Business Institute (HBI) Certification - Hospital Business Institute (HBI) - upon hire - Preferred

To carry out its mission, CHOP is committed to supporting the health of our patients, families, workforce, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

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SALARY RANGE:

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.

Originally posted on Himalayas