Senior Director Enterprise Patient Access and Financial Clearance

KEY RESPONSIBILITIES

• Provide enterprise leadership for Patient Access, ADT, Registration, Financial Clearance, and the centralized PAC functions across all RI and MA entities.
• Standardize all policies, workflows, KPIs, and training across Rhode Island and Massachusetts regions under one centralized leadership team to ensure accountability and alignment.
• Lead and manage Directors of Hospital Patient Access (RI & MA) and the Director of Ambulatory Patient Access (PAC), ensuring site-based directors manage day-to-day operations while maintaining enterprise standards.
• Drive the strategic separation of patient-facing, real-time activities (hospital-based teams) from payer-facing, standardized functions (centralized PAC), reducing duplication and eliminating conflicting workflows across facilities.
• Leverage Epic tools to drive standardization, workqueue accountability, automation, and denial prevention—ensuring the organization maximizes its Epic investment.
• Partner with IT to optimize Epic workflows, build rules, automation, and real-time reporting dashboards.
• Oversee Epic workqueue ownership mapping and accountability grids across PAC vs. hospital-based registration/financial clearance models.
• Centralized Patient Access Center (PAC) Oversight: Oversee the corporate PAC shared services model, including:
• Pre-registration & Insurance Verification — Validating demographics and insurance data prior to date of service across all entities.
• Authorization Management — Submission, follow-up, and documentation tracking for inpatient, outpatient, high-tech radiology, and surgical day care services.
• Eligibility & Benefits Verification — Interpreting payer responses, identifying requirements for prior authorizations, referrals, and medical necessity validation.
• Financial Clearance — Centralized pre-service financial clearance, estimates, and POS collections.
• Denials Prevention — Proactive strategies to reduce access-related claim denials and improve clean claim performance.
• On-Site / Hospital-Based Access Operations: Ensure hospital-based teams retain ownership of activities requiring physical presence, immediate clinical coordination, and direct patient interaction, including:
• ED Registration & Triage Registration.
• Bedside / Inpatient Admitting & ADT.
• Outpatient Front Desk Check-In.
• Point-of-Service Financial Counseling & Collections.
• Consent & Document Collection.
• Medicaid & Charity Program Support.
• Rewards & Collections.
• Revenue Integrity & Denial Prevention: Develop and execute strategies to reduce access-related denials and improve clean claim performance across HB and PB.
• Compliance & Regulatory: Ensure compliance with federal, state (RI & MA), and payer regulations including CMS, HIPAA, No Surprises Act, and MassHealth requirements.
• Patient Experience: Champion a patient-centered access experience across all touchpoints—from pre-service through discharge—recognizing that revenue cycle has among the most patient interactions before and after care.
• Implement digital access innovations including MyChart integration, eCheck-In adoption, and automated patient communication.
• Leadership & Team Development: Lead and develop a multi-level leadership team including Directors, Managers, Supervisors, and Team Leads across RI and MA.
• Drive staff recruitment, retention, performance management, and succession planning.
• Foster a culture of accountability, continuous improvement, and professional development.
• Cross-functional collaboration and stakeholder management: Collaborate cross-functionally with Finance, HIM, Coding, Compliance, Clinical Operations, Payer Contracting, and IT.

QUALIFICATIONS / EDUCATION

• Bachelor’s degree in business, Health Information Management, Finance, Healthcare Administration, or related field.
• Minimum 8–10 years of progressive leadership in patient access, revenue cycle, or healthcare operations, with at least 5 years in a senior management role in a large, multi-entity health system.
• Epic Proficiency: Extensive hands-on experience with Epic Prelude, Cadence, ADT, Grand Central, Resolute HB/PB, and associated revenue cycle modules in an enterprise environment.
• Deep understanding of hospital and professional billing workflows, payer requirements, authorization processes, and financial clearance operations.
• Demonstrated success in denial prevention, clean claim optimization, and access-related KPI improvement.
• Knowledge of CMS, HIPAA, No Surprises Act, state regulations (RI/MA), and payer-specific policies.
• Preferred Education: Master’s degree (MBA, MHA, or equivalent).
• Certification: CHAM (Certified Healthcare Access Manager), CHFP, or equivalent professional certification.
• Experience leading centralized Patient Access Center / shared services models in a multi-state, multi-entity academic health system.
• Experience with Epic implementations, go-lives, and system transitions (e.g., legacy system migrations to Epic).
• Familiarity with HFMA, MGMA, and NAHAM benchmarking standards.
• Experience managing access operations during acquisitions, CHOW events, and new entity integrations.