Director Patient Access Financial Clearance

Job Description

The Director Patient Access – Financial Clearance is accountable for system‑wide leadership and operational oversight of pre‑service activities that ensure patients are financially cleared prior to receiving care. This role directs teams responsible for pre‑registrations, insurance verifications, prior authorizations, financial clearance for scheduled patients, inpatient notification submission, single case agreement (SCA) coordination, denials review and analysis, authorization follow‑up for procedure changes, and management of claim edit, stop bill, and DNB work queues. The director drives standardization, quality, system wide training and throughput, partnering closely with clinical operations, payer relations, utilization management, case management, and revenue cycle to protect access, minimize financial risk, and accelerate clean claims.

Responsibilities

• Pre‑Registration & Front-End Operations
• Leads strategy and daily operations for pre‑registration to ensure accuracy, completeness, and timeliness.
• Monitors productivity and quality for centralized and site‑based teams to drive consistent performance.
• Insurance Verification & Financial Clearance
• 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.
• Prior Authorization & Clinical Documentation
• Designs and enforce 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.
• Notifications, Denials Prevention & Performance Analytics
• Oversees inpatient notification accuracy and turnaround times, escalating aging cases appropriately.
• Leads 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.
• Work Queue Governance (Claim Edit, Stop Bill, DNB)
• 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.
• Implement 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 set stretch goals
• Governance, Compliance & Leadership
• Develops policies, SOPs, competencies, and governance standards for financial clearance operations; ensures compliance with regulatory and payer requirements (EMTALA, HIPAA, Joint Commission, state/federal).
• Facilitates collaboration with Scheduling, Clinics, Surgery, Imaging, Payer Relations, UM/CM, CDI/Coding, Billing, and IT/EBP teams.
• Recruits, develops, and leads supervisors and specialists while fostering a culture of accountability, service excellence, and continuous improvement.
  
  

Qualifications

• 7 years relevant healthcare experience (in total); of which
• 4 years should be in patient access management, extensive customer service or other revenue cycle roles; and
• 2 years of manager/supervisor/team lead roles
• Bachelor's degree in related field or equivalent combination of education and directly related experience may be considered.
• Advanced computer skills: judgment, analytical skills and communication skills required to accomplish goals in settings that are often sensitive.