Director Patient Access Financial Clearance

Responsibilities

• Leads strategy and daily operations for pre-registration to ensure accuracy, completeness, and timeliness.
• Makes sure productivity and quality for centralized and site-based teams are driven consistently.
• Oversees verification of coverage, eligibility, benefits, coordination of benefits, and patient financial responsibility.
• Directs financial clearance processes including medical necessity checks, estimate generation, upfront collections, payment plans, charity screening, and financial counseling referrals.
• Collaborates with Payer Relations to address out-of-network coverage, exceptions, and benefit clarification.
• Designs and enforces prior authorization workflows aligned with payer rules and documentation requirements.
• Ensures complete audit trails for requests, approvals, denials, peer-to-peer escalations, and clinical records.
• Oversees inpatient notification accuracy and turnaround times, escalating aging cases appropriately.
• Ledges root-cause analysis of pre-service and authorization-related denials and drives corrective action.
• Builds and interprets dashboards, trends, and performance reports; collaborates with Patient Access, UM/CM, Coding, and Billing to implement improvements and education.
• Manages daily resolution of Claim Edit, Stop Bill, and DNB queues to support clean claim submission.
• Establishes SLAs, prioritization logic, and escalation pathways for efficient cross-functional issue resolution.
• Implements process controls, front-end edits, automation, and training to reduce rework and prevent recurring errors.
• Ensures adherence to federal/state regulations, payer policies, EMTALA (for emergency stabilization), HIPAA privacy/security, and Joint Commission standards.
• Maintains robust documentation and audit readiness for authorizations, financial counseling, and payer communications.
• Publishes system-wide reports on throughput, quality, and financial impact.
• Benchmarks against industry standards and sets stretch goals.

Qualifications

• 10 years progressively responsible healthcare revenue cycle experience with 4 years in patient access/financial clearance leadership.
• Bachelor's degree required.