Enterprise Financial Clearance Manager

Job Number 62491
Posted 8/28/2019
Account Northern Light Health Home Office
Department Patient Financial Services
Location |ME| Northern Light Health Home Office - Godfrey Dr., Orono, ME 04473
Schedule Regular Full-time
Shift Day
Hours 8:00 - 4:30
Job Details Job Summary

The Enterprise Financial Clearance Manager reports directlyto the Northern Light Health Associate Vice President of Patient Access. This position serves to improve the overalleffectiveness of Revenue Cycle financial clearance policies, practices, andtechnology platforms for all NLH organizations. The primary responsibilities ofthis role are to serve as an internal subject matter expert and oversee allaspects of daily operations including supervising the activities of thefinancial clearance team(s), assisting with the development of policies,procedures, and processes, and coordinating with integrated departments toensure financial security and patient satisfaction through increased pricingtransparency, reduced denials, and decreased patient wait times . The Enterprise Financial Clearance Managerwill provide direction and leadership for staff completing registrations priorto the date of service, including obtaining demographic information, verifyinginsurance information, ensuring prior authorization and medical necessityrequirements are met, and reviewing financial obligations with patients. This leader will support, track, manage, andchampion Revenue Cycle Patient Access initiatives with emphasis on financialclearance functions and downstream impact, sharing results with keystakeholders. This role will serve as aleading resource in the areas of process improvement, organizationaldevelopment, change management, performance monitoring, and other analytics. This position will facilitate projects andwill apply influential techniques to lead teams toward best practice solutions. Strong communication and leadership skills arerequired.

Education andExperience

·Bachelor's degree required or currently enrolled in a Bachelor's degree program.

·Five(5) years of progressively responsible management level experience in a similar size and scope organization or system.

·Certified Revenue Cycle Professional certificate preferred.

Required Minimum Knowledge, Skills andAbilities

·Detailed knowledge of Revenue Cycle,specific to financial clearance functionality, approaches, workflows, andbenchmark goals.

·Working knowledge of all functionalareas of the revenue cycle.

·Ability to interpret an extensivevariety of instructions furnished in written, oral, diagram, or schematicform. Analytical skills required todecipher data and share outcomes.

·Excellent communications skills, bothoral and written.

·Intermediate Microsoft softwareknowledge and ability to train/assist end-users in applicable programs.

·Flexible and organized, to be able to reactto ever changing priorities.

·Experience with NLH Software, data andbusiness information is preferred.

Essential Functions

The Enterprise Financial Clearance Manager will report tothe Northern Light Health Associate Vice President of Patient Access. Thisrole will collaborate with the other Revenue Cycle functions to engageappropriate resources and lead initiatives for financial clearance relatedworkflows and process improvement for the department. These tactics may involve the need to: gather requirements, analyze findings, designsolutions, review specifications and implement new and improved processes,while maintaining ongoing measurements and tracking mechanisms. Effectiveness of this position will bemeasured in terms of management of teams to achieve measurable outcomes throughproductivity methods and KPI reporting, development of employee engagement andskillsets, as well as customer service satisfaction.

This position is a member of the NLH Revenue Cycleteam. Duties may be changed orreassigned by the Vice President of Revenue Cycle as needs arise.


·Manages staff; interviews, hires,assigns, and directs work, while serving as a mentor for department staff,providing both reward and discipline appropriately.

·Holds staff accountable for progress offinancial clearance initiatives and implements quality management measures forproductivity, time and attendance, and other team opportunities.

·Develops and maintains communicationchannels with staff through department meetings, email, and individualcoaching.

·Collaborates with physician offices andhospital departments as needed, to assist with complications during the priorauthorization or medical necessity processes.Coordinates with case management, registration, and other areas asnecessary.


·Collaborates with partneringdepartments to drive successful operational performance and to ensure clinicalimpact and patient safety are maintained.

·Champions patient facing registrationinitiatives and upholds customer service standards throughout.

·Works within the team to assist asneeded, contributing to the overall success of the department. Advises staff ofnecessary connections between pre-registration and financial counseling toensure accounts are handled appropriately.


·Reviews workflows to identifyfragmented processes and makes recommendations for improvement. Provides consistent messaging and educationon prioritization, both of workflows and initiatives.

·Ensures financial clearance processesare in line with all state and federal requirements, and that HIPAA policiesare maintained.

·Ensures patient demographic informationincluding insurance verification, benefits assessments, patient liabilityestimates, prior-authorization and medical necessity checks, and collection attempts are completed onaccounts in advance of services rendered (with exception to late add onencounters). Holds team accountable forappropriate account documentation.


·Establishes and tracks key revenuecycle performance indicators and reports key findings to appropriate leadership.

·Manages department presentations anddesigns action plans as issues are identified within the area.

·Assists in the development of theoperational budget and manages within the budget; monitoring expenses tosupport the department's financial goals.

·Champions POS collections initiatives,holding accountability for collection attempts throughout the process toincrease revenue prior to patients presenting to registration on site.


·Leads the implementation, design andoptimization of financial clearance management software.

·Serves as a project facilitator forteams working on major, complex performance improvement efforts.

·Provides consistent rounding withimmediate team, for professional development opportunities. Promotes a supportive and encouragingenvironment for staff.

·Demonstrates excellent understanding ofinsurance terminology, payer contracts, and legal changes in order toeffectively communicate to the team and change processes as necessary.


·Oversees the handling of "special"requests, complaints, or inquiries regarding worklows, patient accounts, orchanges to system processes, to ensure correct and satisfactory resolution.

·Coordinates the resolution of concernstimely, looking for a proactive approach to prevent reoccurrence.

Organizational Values

Passion: We demonstrate a passion forcaring for others and the pursuit of service excellence in all that we do.

Integrity: We commit to the higheststandards of behavior and doing the correct thing for the right reasons.

Partnership: Working together incollaboration and teamwork is more powerful than working alone.

Accountability: We take a responsibleand disciplined approach to achieving our priorities and responding to an everchanging environment.

Innovation: We are capable ofextraordinary creativity and are willing to explore new ideas to achieve ourhealthcare mission.

Respect: We respect the dignity, worthand rights of others.

Safety Requirements

·Assists in maintaining a work environment freefrom recognized hazards that create a risk or injury to employees, patients, orvisitors.

·Ensures all accidents and incidents are reportedby employees within 24 hours and supervisor to submit properly investigated reporttimely.

·Completes ergonomic evaluations as needed.

·When appropriate, assists and supports with thereturn of all workers with work related injuries and illness to gainfulemployment.

Physical Demands

·Sedentary:Exerting up to 10 lbs. occasionally, sitting most of the time, and onlybrief periods of standing and walking.

·Requires the ability to travel to memberorganizations as needed. Employee musthave a valid driver's license and possess own transportation.

Note: the duties listed above reflect themajority of the essential duties of this job and does not, nor is it intendedto, reflect all essential duties that may be required for an incumbent in thisjob to perform.

Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.

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