• Responsible for financial claims expense invoicing, reporting, analysis and forecasting • Develop, analyze, interpret, report, and present historical and/or forecasted financial claims expense and stop loss coverage information • Prepare claims expense financials, estimated claim expense and financial forecasts • Prepare financial and business-related analysis and research • Coordinate and direct the preparation of stop loss coverage for employer groups or stop loss vendors

• Leads, coordinates, and supports provider compensation and revenue cycle analysis for assigned support group • Provide analytical support for the development and measurement of production, compensation, and operational targets and models • Monitor and analyze provider revenue cycle indicators, identifying opportunities for improved performance • Work with Regional Administrators, Hospital and Physician Leadership, to ensure productivity/compensation are reported and paid accurately and timely • Ensure accurate budgeting and strong monitoring of financial results to maximize efficiency and identify margin enhancement opportunities • Coordinate provider performance and compensation analysis and reporting process • Independently analyze and complete monthly performance reports for non-academic provider practice entities • Maintain physician compensation and contract management software • Monitor total compensation payments made to providers to ensure compliance with compensation plan • Communicate with leadership regarding negative variances and rolling projections • Continuously monitor revenue cycle performance improvement opportunities • Develop & Monitor Physician compensation Models • Oversee the maintenance of physician compensation plans, incentive payment calculations, and productivity tools & reports • Collaborate with Hospital Finance & Reimbursement team on financial projections

• Responsible for planning, organizing, leading and directing the overall patient financial clearance functions • Ensures financial clearance functions are performed efficiently throughout the Patient Access services enterprise • Maintains a complete record of current policies and procedures followed by staff • Develops goals and priorities, and assigns tasks and projects • Provides effective leadership and manages appropriate staff levels • Collaborates with other departments to ensure processes and systems for patient financial clearance are standardized and optimized

• Completes insurance verification, eligibility and benefit determination process utilizing integrated electronic eligibility system, payer websites, and phone for all insurance plans within the scope of the patient financial clearance department and assigned service line. • Interprets and documents the appropriate co-pay, deductible, share of cost, co-insurance, maximum benefit levels and/or available days. • Contacts patient as appropriate to obtain correct and updated information when necessary. • Completes Medicare Secondary Questionnaire as appropriate. • Applies authorization rules and requirements for all payors within the assigned work queues. • Develops a strong working knowledge of the procedures and diagnosis used in the assigned service-lines to ensure authorizations are properly completed for the scope of services that will be rendered to the patient. • Assesses the data required for authorization and securing sponsorship. • Communicates with respective clinics and referring providers to secure appropriate information to complete an authorization. • Follows up on pending authorization and referral requests to ensure timely completion and secured sponsorship for cases in the assigned work queue. • Arranges escalation process for clinics and clinicians to complete peer-to-peer appeal reviews with payor utilization management when needed. • Prioritizes work assigned to them to ensure that financial risk is minimized, and timely completion of authorizations is optimized, while meeting daily productivity measure goals. • Identifies risk associated with coverage and benefit issues related to the services that are being requested for authorization and escalates these issues to appropriate experts to address. • Identifies risk associated with securing financial clearance prior to service date and escalates to clinic and other resources to find an appropriate course of action (e.g. reschedule, cancel, sign PAFR). • Understands the role of financial counseling in securing clearance for cases that do not have authorization secured timely. • Properly refers these cases as appropriate. • Notifies the department manager with issues, instances of errors, or obstacles to successful completion of work. • Applies strong writing skills to account documentation, email communication and internal notes/memos. • Manages outbound and inbound phone calls. • Responds promptly to customer inquiries. • Assists team coordinator and department manager with special projects as needed. • Serves as a resource for other payor authorization teams. • Performs other duties and responsibilities as assigned by the Department.