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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)
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)

Licenses and Certifications

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

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 be fully vaccinated against COVID-19 and receive an annual influenza vaccine. Learn more.
Employees may request exemptions for valid religious and medical reasons. Start dates may be delayed until candidates are immunized or exemption requests are reviewed.
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