Job Details

Financial Clearance Specialist

At St. Luke's, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke's is truly a great place to work.

The Financial Clearance Specialist ensures a seamless patient experience by verifying financial eligibility, securing prior authorizations, providing price transparency and facilitating accurate financial clearance for services. The role collaborates with patients, insurance companies, registration/billing team members, and clinical and hospital staff to ensure patients are financially cleared before receiving medical services and collecting payments towards deductibles and co-insurance.

Obtain pre-authorizations and referrals from insurance companies to include submission of medical records and authorization documentation

Create patient liability estimates based on the plan's policy and benefits. Inform patients of their financial responsibility and collect payment towards out-of-pocket costs

Validate CPT codes associated with procedure are accurate

Verify patients' insurance coverage including multiple payer and government payers. Verify co-pays, deductibles and out-of-pocket patient responsibility

Work with medical staff to ensure timely and accurate financial clearance including coordinating peer-to-peer reviews and obtaining medical record documentation for insurance companies

Ensure patients and family members stay informed of pre-authorization status. Generate and deliver non-covered services, referring patients to possible financial assistance when necessary

Monitor payer's network status and communicate status to patients. Initiate gap authorization and single-case agreement workflows when appropriate

Accurately document all financial clearance activities in the patient's electronic health record (EHR)

Confirm provider associated with procedure is credentialed with payer

Respond to e-mails and phone calls from patients and staff members requesting cost estimates

This position works under general supervision resolving typically straightforward issues, escalates more complex problems to senior levels

Performs other duties as required

Qualifications:

Education: HSD/GED

Experience: One (1) year relevant experience

What's in it for you At St. Luke's, caring for people in the communities we serve is our mission and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals. St. Luke's is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.