System Mgr. Financial Clearance Authorization Services-26619

About the role

The System Manager of Financial Clearance – Pre-Authorization Services provides strategic leadership and operational oversight of pre-authorization functions supporting ambulatory clinics and hospital-based services across the Rush University System for Health.

Responsibilities

• Provide leadership and operational oversight for financial clearance teams responsible for securing prior authorizations across multiple outpatient and hospital-based service lines.
• Ensure staff follow standardized workflows for obtaining authorizations in accordance with payer policies, medical necessity guidelines, and service-specific requirements.
• Oversee authorization operations for diagnostic imaging, surgical procedures, outpatient procedures, in-office procedures, and infusion services, ensuring appropriate clinical information is obtained and submitted to payers.
• Maintain operational knowledge of complex payer requirements, authorization pathways, and service-specific review criteria that impact approval outcomes.
• Provide subject matter expertise in authorization lifecycle management, including order review, clinical documentation verification, submission processes, payer follow-up, and approval tracking.
• Ensure appropriate alignment between clinical orders, procedural coding, and payer authorization requirements to support accurate submission and approval.
• Maintain expertise in payer medical necessity guidelines, documentation requirements, and service-specific authorization pathways.
• Identify and resolve operational barriers that delay or prevent authorization approvals.
• Serve as an operational expert in Epic authorization and referral workflows, including order-driven authorization processes, work queues, and authorization tracking tools.
• Partner with information technology and revenue cycle leadership to improve Epic workflows related to authorization management, clinical documentation integration, and operational reporting.
• Support implementation and optimization of automation tools and technology solutions that improve authorization efficiency and payer communication.
• Monitor authorization approval rates, payer turnaround times, and denial trends to identify operational risks and revenue protection opportunities.
• Develop and implement strategies to reduce authorization-related denials and payer escalations.
• Collaborate with revenue cycle leadership to support financial clearance metrics and organizational revenue goals.
• Ensure staff follows the Point of Service Collection.
• Partner closely with physicians, advanced practice providers, and clinic leadership to ensure clinical documentation and supporting information align with payer requirements.
• Provide expertise to clinical departments regarding payer policies, medical necessity documentation, and authorization submission requirements.
• Serve as a liaison between clinical teams, financial clearance staff, and revenue cycle operations to resolve authorization barriers and support timely patient care.
• Recruit, train, mentor, and manage financial clearance staff responsible for authorization operations.
• Develop team expertise in complex payer authorization requirements, service-specific workflows, and clinical documentation standards.
• Establish productivity, quality, and service level expectations for authorization teams.
• Foster a culture of accountability, collaboration, and operational excellence.
• Lead initiatives to improve authorization turnaround times, reduce rework, and strengthen documentation accuracy.
• Analyze operational workflows to identify opportunities for standardization, automation, and improved payer response management.
• Drive continuous improvement initiatives that strengthen financial clearance performance and revenue protection.
• Monitor key performance indicators including authorization turnaround times, approval rates, denial trends, payer response timelines, and service level compliance.
• Develop operational reporting to identify workflow gaps, payer issues, and process improvement opportunities.
• Provide leadership with actionable insights related to authorization performance and revenue cycle impact.

Qualifications

• Education: Bachelor’s degree in healthcare administration, Business Administration, Finance, or a related field required. Master’s degree preferred.
• Experience: Minimum of 5–7 years of experience in healthcare revenue cycle operations, with significant focus in prior authorization, financial clearance, or patient access functions. Minimum of 3 years of leadership or management experience, preferably in a system or multi-site environment.
• Knowledge & Skills: Advanced knowledge of payer authorization requirements, medical necessity policies, and reimbursement guidelines. Strong understanding of authorization lifecycle management, including clinical documentation requirements and payer review processes. Demonstrated expertise in Epic authorization workflows, work queues, and electronic order-driven authorization processes. Ability to interpret payer policies and translate requirements into operational workflows. Experience analyzing operational and financial performance data to support denial prevention and revenue optimization. Strong leadership, communication, and relationship-management skills. Exceptional organizational, analytical, and problem-solving abilities. Ability to lead operational improvements in a complex healthcare environment.