Manager, PB Pre-Bill, Eligibility, and Financial Clearance at St. Josephs Candler – Savannah, Georgia

The Manager of Physician Pre-Bill, Eligibility, and Financial Clearance is a key leadership role within the Revenue Cycle, responsible for the strategic and operational oversight of the front-end financial integrity. This position serves as the primary architect for ensuring that all physician services—spanning primary care and various specialties—are medically authorized, financially cleared, and accurately billed before submission.

The Manager leads a multi-functional team dedicated to the critical lifecycle of a claim starting with the verification of complex eligibility, the securing of VA and Medicaid authorizations, and the management of the Financial Clearance process. A significant focus of this role is patient advocacy and risk mitigation; the Manager oversees programs for Charity Care and Pending Medicaid, ensuring that uninsured or underinsured patients are screened for assistance to stabilize the hospital's uncompensated care costs.

As a data-driven leader, the Manager utilizes advanced analytics to monitor clearinghouse functionality, audit claim quality, and track Key Performance Indicators (KPIs) such as Clean Claim Rates and Denial trends. By collaborating closely with other leadership, the Manager identifies payer submission trends and implements innovative technology to streamline posting processes. The ultimate goal of this position is to maximize cash flow and minimize administrative denials while fostering a high-performance culture that adheres to all Federal and State Medicare/Medicaid regulations.

5 Years management experience within physician billing, eligibility, or collections, preferably within a multi-specialty or hospital setting - Required

None Required

Directs and coordinates daily activities for the Physician Pre-Billing, Eligibility, and Specialty Billing teams. Manages the full financial clearance process, including VA and Medicaid authorizations, insurance verification, and patient financial screening. Oversees the submission of claims via the billing clearinghouse, identifying payer trends and managing functionality to ensure high Clean Claim Rates. Directs the preparation and generation of client invoices and supporting documentation for specialty billing.

Leads the financial clearance team in identifying responsible parties and securing necessary authorizations before patient encounters. Manages the Charity Care and Pending Medicaid programs, ensuring patients are screened for financial assistance and navigated through the application process. Monitors and provides feedback on demographic registration errors and insurance verification omissions to reduce Claim Denials.

Hires, trains, coaches, and evaluates staff performance; handles disciplinary actions and terminations as necessary. Maintains up-to-date employee records, including clinical competencies, job descriptions, and site orientations. Ensures all team members adhere to system policies, HIPAA regulations, and HR procedures.

Utilizes data analytics to track, trend, and report on monthly KPIs, including cash collections, Days in A/R, and denial rates. Communicates significant billing or payer issues to executive leadership via monthly financial analysis reports. Oversees claim auditor productivity and quality to ensure efficient posting processes and compliance with Federal and State Medicare/Medicaid regulations.