Financial Verification Manager

RemoteFull-Timemid

OtherManager

2 views0 saves0 applied

Apply Now

Quick Summary

Overview

The vision of Clinical Health Network for Transformation (CHN) is to support the mission and promise of Planned Parenthood to bring high-quality, affordable care to every member of our communities. CHN is a collaboration between Planned Parenthood affiliates across the United States.

Technical Tools

exceldata-analysisperformance-management

The vision of Clinical Health Network for Transformation (CHN) is to support the mission and promise of Planned Parenthood to bring high-quality, affordable care to every member of our communities. CHN is a collaboration between Planned Parenthood affiliates across the United States.

CHN is looking for individuals who are committed to supporting our shared goal of strengthening and enhancing our awareness and commitment to advancing the cause of health equity in our organization.

The Financial Verification Manager is responsible for oversight and operational management of financial verification and financial clearance functions across Clinical Health Network for Transformation (CHN). This role oversees daily operations related to insurance verification, prior authorizations, referral management, eligibility review, and registration-based denial prevention to support timely patient access and reimbursement outcomes.

The Financial Verification Manager provides leadership and support to the Financial Verification Supervisor and a team of Financial Verification Specialists. This role is responsible for ensuring operational efficiency, quality assurance, workflow compliance, and strong affiliate partner relationships while supporting accurate and timely completion of financial clearance activities prior to patient visits.

This position serves as a key operational liaison between CHN, affiliate partners, Revenue Cycle, Patient Access, and frontline operational teams to resolve issues, improve workflows, and maintain high-quality financial verification processes.

Provide operational leadership and oversight of centralized financial clearance operations including insurance verification, prior authorizations, referral management, eligibility validation, pre-service financial clearance activities, payer policies, and denials review

Direct and support daily operations of the Financial Verification team through leadership of the Financial Verification Supervisor and indirect oversight of the Financial Verification Specialists

Main point of contact for CHN and affiliates regarding front end insurance entry and review workflows, to include but not limited to:

Determine eligibility and benefits for services
Authorization requirements, or status of submitted authorizations
Provide price estimates, to include deductibles, coinsurance and copayments for scheduled services
Create and maintain payment plans
Field inquiries about statements and Explanations of Benefits (EOB)
Provide financial assistance
Address patient complaints
Self-pay costs for inactive coverages
Support onboarding, training, coaching, and performance management initiatives for supervisory and frontline staff to promote accountability, engagement, and operational excellence
Conduct and oversee quality assurance audits of insurance verification, authorization, referral, and financial clearance workflows to ensure accuracy, compliance, and adherence to payer and organizational requirements
Oversee payer portal governance, operational access management, and workqueue integrity to ensure appropriate workflow routing and continuity of operations
Develop, implement, and maintain standardized workflows, policies, procedures, training materials, and quality monitoring processes to support operational consistency and scalability by making data driven decision
Produce and analyze operational trends and reporting related to denials, authorization outcomes, verification accuracy, productivity, and financial clearance performance to support process improvement initiatives
Present cohesive business cases relying on data analytics for change to senior leadership and affiliates to make the case for change. Partner cross-functionally with Revenue Cycle, Patient Access, Operations, Clinical, and Leadership teams to improve front-end revenue cycle performance and operational efficiency
Serve as a subject matter expert and operational escalation point for complex payer issues, payor updates and changes, authorization barriers, financial clearance concerns, and affiliate partner requests
Build and maintain collaborative operational relationships with affiliate partners to support service delivery, issue resolution, workflow alignment, and ongoing operational support
Ensure compliance with payer requirements, organizational policies, regulatory standards, and affiliate contractual expectations related to financial clearance operations
Demonstrate an elevated level of integrity and innovative thinking and actively contribute to the success of the organization
Monitor operational performance metrics, service level agreements (SLAs), productivity standards, quality outcomes, and turnaround times to ensure achievement of organizational and affiliate expectations
Lead continuous improvement initiatives focused on workflow optimization, operational efficiency, denial mitigation, and enhanced affiliate and patient experience outcomes across internal and external stakeholders
Oversight of hiring, coaching, and routine performance review directly with all finanancial verification staff, to develop and support a high-performance team that meets organizational and department goals
Problem-solve escalated concerns from CHN member affiliate health centers and/or patients
Work with CHN leadership in development of short- and long-term business and strategic plans and organizational structure within the Access Operations Department
Upholds organizational values and standards, while proactively seeking ways to improve efficiency, equity, and service excellence
Ensure compliance with all CHN and affiliate policies, as well as all state and federal regulations
Provides positive and development feedback and accountability related to all practices
Demonstrates commitment to CHN and Planned Parenthood’s health equity mission, with emphasis on racial equity and community accountability. Demonstrates dedication to learning about racial equity and addressing structural racism in healthcare
Consistently delivers high-quality results using sound judgment and data-driven decisions. Prioritizes customer needs by providing prompt, accurate service to all stakeholders

The above duties and responsibilities are not an exhaustive list of required responsibilities, duties, and skills. Other duties may be added, and this job description can be amended at any time.

Bachelor’s degree and/or higher-education level or completed coursework in business or health services administration, or equivalent experience

Minimum 2 years of leadership or supervisory experience in Financial Verification, Revenue Cycle, or Patient Access

Minimum 5 years of Financial Verification experience

Proven experience with staff recruitment and management

Strong understanding of:

Insurance verification
Prior authorizations
Referral workflows
Financial clearance operations
Registration accuracy and denial prevention
Experience managing operational workflows and staff performance within a healthcare setting.
Experience with the following systems:
- Epic EHR
- Including but not limited to workqueue access, reporting, inbasket workflows
- Availity
- Insurance Payor PortalsStrong communications and leadership skills, while acting as a role model and coaching team members.
- Strong analytical and problem-solving abilities
- Proficiency with Microsoft software (Excel, etc.)
- Demonstrated ability to maintain affiliate-centric service approach
- Excellent written and verbal communication skills and ability to collaborate and interact with all levels within and outside of CHN, if necessary
- Strong attention to detail and follow-up; and ability to effectively prioritize deliverables
- Demonstrated dedication to Planned Parenthood’s mission, vision, and values
- Strong interpersonal skills and the ability to build relationships
- Excellent time management and problem-solving skills
- Willingness to travel in accordance with the needs of the position, as outlined in the essential functions. Compliance with all CHN travel policies, including safety guidelines while operating a personal vehicle

5+ years of relevant experience at the management level

Commitment to advancing race(+) equity in one’s work: interested in expanding knowledge about the role that racial inequity plays in our society

Awareness of multiple group identities and their dynamics, bringing a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions

Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity with the aim to learn

Strong sense of accountability to equitable practices

Understanding of the impact of identity dynamics on organizational culture

Commitment to CHN and Planned Parenthood’s In This Together service ethos, workplace values, and service standards

Clinical Health Network for Transformation (CHN) is an equal employment opportunity employer. We comply with all applicable laws prohibiting discrimination based on race, color, religion, gender and gender expression/identity, age, ethnicity, national origin, ancestry, physical or mental disability, uniformed service member/veteran status, marital status, medical condition, pregnancy, sexual orientation, citizenship status, genetic information, as well as any other category protected by federal, state, or local. We are committed to building an inclusive workplace that values racial & social justice. We strongly encourage all persons to apply, including members from all racial and ethnic groups and members of the LGBTQIA+ community.