Executive Director Financial Clearance

Site: Mass General Brigham Incorporated

At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission-from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.

At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare - people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds - to apply.

Job Summary
Provides leadership, efficient, effective oversight of patient financial clearance activities and teams. In partnership with key stakeholders, the Executive Director, Financial Clearance plans and contributes to insurance referral and prior authorization strategy, and continuously works to improve people, process, and technology across the function. The Executive Director, Financial Clearance guides a team of leaders who oversee managed care/referral and prior authorization specialists, who are responsible for verifying insurance eligibility and for obtaining insurance referrals and prior authorizations. The teams are also responsible for checking whether visits meet payer medical necessity guidelines and take appropriate action when they do not. The Executive Director will ensure that our team facilitates the necessary administrative procedures to reduce preventable authorization denials, and to ensure that accounts are financially cleared prior to service. This role is also key in socializing and upholding our financial clearance adherence policy.

In partnership with key stakeholders, the Executive Director, Financial Clearance is responsible for defining and executing financial clearance strategy, and continuously works to improve people, process, and technology across the function. This role is also responsible for modeling and championing the revenue cycle culture including the ACE principles: Authentic, Collaborative and Engaged, and creating a team that embodies those values.

Qualifications

Principal Duties and Responsibilities:

Leadership Impact & Problem Solving

• Sets the strategic direction for Financial Clearance and collaborates with direct reports and entity leaders to drive alignment.

• Aligns MGB Financial Clearance deployment with Mass General Brigham's enterprise strategy, standardizing processes and creating one Financial Clearance team for the organization
• Drives focus, efficiency, and role clarity across teams focused on patient financial clearance denial prevention activities.
• Foresees and mitigates any significant risks in financial clearance (Ex. work queue backlog, payer delays and denial tactics, etc...).
• Analyzes trends and root causes and solves complex operational issues (i.e., escalated pending authorizations, denials, identifies optimizations).

• Develops strategy for integration of facility financial clearance teams, and monitors execution; influences stakeholders broadly within and outside of the enterprise.
• Identifies, recommends and develops opportunities to expand scope of services delivered to practices and patients.
• Identifies, recommends and develops plans for integration of new technologies, including AI and automation, to improve performance and reduce cost.
• Participates at a national and local level as a SME (Subject Matter Expert). Communicates relevant changes in performance, market trends, health care delivery systems, and legislative initiatives impacting execution of team goals to team(s).

Financial Performance

• Actively leads, monitors and drives financial planning strategies to support a cost-effective financial clearance program with minimal preventable denials for no authorization and medical necessity

Operational Performance

• Develops and implements efficient and effective operational policies, processes, best practices, and technologies
• Oversees leadership team responsible for Financial Clearance including identifying and monitoring success metrics and activities related to prior authorization and referral processing
• Facilitates projects and conversations with outside health care organizations to share and develop best practices
• Recommends and engages with third party vendors where business case for performance exists
• Establishes infrastructure for financial clearance within Epic, by partnering with Digital to create waterfall work queues and to create/maintain the ASA table, and tracking / benchmarking outcomes
• Facilitates effective implementation and training regarding referral and prior authorization requirements, payer medical necessity policies, and procedures
• Oversees staff volume management, flexing resources across service line based work queues, as volume demands

Key Interactions

• Patient Access and Experience Team | Collaborate closely with department leader, to help shape Financial Clearance strategy development.
• Case Management/UM | Partners with CM/UM on opportunities related to LOS, inpatient only, NOA and other cross-functional dependencies, to solve problems and reduce denials, delays and rework
• Ambulatory Operations Management| Partners with Ambulatory Ops to ensure seamless patient experience, and sound workflows
• Patient Access Leaders | Communicate approach to and coordinate oversight of provision of comprehensive financial clearance support across the Enterprise.
• Physicians, & Billing Staff | Serve as a resource to physicians and billing staff who have questions regarding referrals and prior authorizations
• Partner Business Units | Work with business units to optimize workflows and improve outcomes
• Business Support Colleagues | Form and maintain strategic alliances with peer colleagues in operations, IT, HR, Facilities, Practices, Physician Groups and Hospitals.
• Quality, Education, & Training Lead | Collaborate to build effective training strategies to increase accuracy and quality outcomes of financially cleared cases

Decision Rights

Accountable

• Develop Financial Clearance Strategies & Approach.

Responsible

• Work collaboratively with leaders across the system to standardize financial clearance procedures, metrics and policies.
• Identify and Monitor Key Performance Indicators within Financial Clearance
• Prioritize Patient Access & Experience Resources within Financial Clearance
• Design and implement strategy within Financial Clearance
• Develop financial clearance operational budgets and ensure good financial stewardship
• Define financial clearance annual goals, socialize them with the team and work together to achieve them

Consulted

• Define Policies and Practices for the larger Patient Access & Experience Team, relative to financial clearance
• Develop Revenue Cycle Operational Budgets

Informed

• Develop Enterprise-Wide Revenue Cycle Strategy.

Other duties and responsibilities as assigned.

Additional Job Details (if applicable)

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

EEO Statement:

Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.