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Financial Clearance Manager - Access, Full-time, Days

Chicago, Illinois Job REQID 6319 Job Function Management-Business Shift Day Job (1st) Apply Now
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

Description

The Financial Clearance Managerreflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities:

  • Provide oversight for department that ensures all admissions, scheduled surgeries, and certain outpatient procedures are financially cleared at NMH and LFH, to allow for maximum and timely reimbursement to Northwestern Medicine Health System.
  • Financial Effectiveness:
    • Establishes and maintains reporting to determine if authorizations and notification are completed timely.
    • Actively monitors systems pre-certification/authorization denials, identifies root causes/trends, and promptly implements remediation plans to prevent future denials.
    • Reviews highest dollar in-house inpatient cases, and performs due diligence with Quality Utilization to ensure reimbursement and minimize financial risk.
    • Develops annual capital and operations budgets; prioritizes requests.
    • Monitors and controls budget expenditures and operating expenses to avoid negative variances.
    • Coordinates the interpretation and enforcement of the department and hospital financial policies and procedures.
    • Seeks to expeditiously and effectively resolve all reimbursement issues which may cause delay in payment.
  • Creative Leadership:
    • Translates organizational vision into the systems departments vision that engages staff in contributing to and achieving that vision.
    • Finds ways to continually improve operational efficiency by leveraging available technology/software, and maximizing the potential of staff members.
  • Time, People and Resource Management:
    • Develops synergies and economies of scale from system-wide merger of financial clearance departments.
    • Establishes, implements, and monitors the health system's Financial Clearance Department's capital and operating budget to achieve defined targets.
    • Recruits and retains staff members consistent with the organization's human resource plan.
    • Ensures compliance with state and federal governmental agencies regarding hospital compliance to guidelines and codes.
    • Takes corrective action regarding violations to ensure divisional compliance.
    • Evaluates current staffing productivity against current volumes and propose necessary staffing changes.
  • Customer Focus:
    • Determines best course of action for patients with high risk/complex financial situations.
    • Actively seeks methods of concurrent and retrospective feedback from customers and outside departments, listens to customer feedback and implements solutions and/or interventions as appropriate.
    • Directs patients, patients family members and hospital staff inquiries about payer requirements and pre-authorization policies.
  • Coaching and Development:
    • Provides daily, just-in-time feedback to improve performance and self-esteem of staff.
    • Tracks coaching discussions and actual performance of associates to ensure accountability.
    • Seeks ways to match staff members talents and career interests with organizational opportunities.
    • Actively supports the health systems strategic goals and objectives and is responsible for ensuring compliance with Northwestern Medicine policies and procedures.
  • Continuous Learning:
    • Continually examines ways to improve business relationships with customers, payers, physicians, procedure schedulers, community, etc.
    • Seeks and is open to new ideas from a wide range of sources; encourages others to share knowledge and best practices.
    • Understands and adapts to new payer and authorization requirements, and constantly changing healthcare landscape.
  • Additional Responsibilities:
    • Assumes accountability for quality of patient financial experience, human resources, revenue cycle and department function.
    • Ensures all staff are trained and developed in all aspects of operations to optimize operational efficiency and effectiveness.
    • Meets targeted goals for department specific turnover and vacancy rates.
    • Develops recruitment and retention plan.
    • Ensures measurement and achievement of key performance indicators of the department and devises improvement strategies where needed to ensure performance.
    • Monitors Epic Work queues (WQs) and dashboards to ensure staff complete necessary fields that trigger appropriate workflow, and reduce outstanding volumes.
    • Utilizes Epic reporting to escalate high-priority, incomplete accounts to manage system metric goals.
    • Reviews Financial Clearance Report Set, and completes report research for the previous week.
    • Use research to determine departmental deficiencies, and create corresponding remediation plans.
    • Devises optimal interdepartmental and system-wide workflows to ensure financial clearance and timely authorizations/notifications.
    • Collaborates with other managers in the delivery of crossover services in all locations.
    • Ensures the development, delivery and maintenance of technical in-service and continuing education programs to ensure the continuing evolution of staff competence.
    • Creates an environment of strong morale and motivated professionals.
    • Monitors the cost accounting of all activity (including research) performed.
    • Control, monitor, analyze and reconcile statistics including revenue and expense.
    • Collaborates with medical/administrative leadership in the development and implementation of programs/systems, which allow for consistent evaluation/treatment in relation to the requirements of patients.
    • Maintains current knowledge of technical/clinical requirement of the department.
    • Assures that standards of practice are developed, communicated implemented and evaluated in a timely and effective manner.
    • Implements and applies service standards established for areas of responsibility within the section and maintains communication with the referring physician customer base to ensure optimal clinical quality.
    • Provides data and reports via established dashboard to department and senior leadership, including quality and financial improvement initiatives, progress on operations and system-wide goals and objectives, and resource utilization related to outcomes measurement.

AA/EOE

Qualifications

Required:

  • Bachelor's degree in healthcare or related field.
  • Progressive leadership with two to three years of management experience.
  • 5-7 years of notification, verification, and authorization professional expertise.
  • Knowledge of payer requirements and managed care contracts.
  • Epic experience.
  • Excellent communication and interpersonal skills.
  • Proficient problem solving and decision making skills, with ability to confront and resolve issues.
  • Skilled at planning, organizing and directing activities of others.

Preferred:

  • Master's degree.

Equal Opportunity

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.
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