Posting Title Specialty Financial Clearance Rep

Overview

e’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.

What You Can Expect:

Under general supervision, the Specialty Financial Clearance Specialist will be responsible for securing prior authorizations for less complex oncology treatments. This includes but is not limited to chemotherapy, radiation therapy, immunotherapy, oncology procedures, specialty labs and supportive medications. This role ensures that patients receive timely treatment by coordinating with insurance providers, healthcare teams, and Patient Financial Advocates to navigate the complexities of insurance coverage and minimize delays in care.

The objective is to reduce financial barriers and delays in care while adhering to payer guidelines.

• Works with providers, pharmacists, pharmacy staff, coders, and insurance companies, to navigate the treatment authorization process and secure prior authorizations for oncology treatments, surgeries, specialty drugs, specialty labs, supportive care and other oncology-related services.
• Handles routine and lower-complexity oncology treatment plan and service authorizations referring the more complex cases to the Senior Specialist.
• Possess a working knowledge of oncology treatments, medical necessity guidelines, clinical documentation, medical policies, and payer requirements to prevent treatment delays and ensure compliance.
• Submits, tracks, and follows up on authorization requests, prioritizing urgent cases as needed. Collaborates with insurance carrier appeal teams and clinical teams to resolve denials and appeals efficiently, and coordinates peer-to-peer reviews.
• Communicates with insurance carriers to clarify policies, coverage limitations, and pre-certification requirements. Coordinates with clinical teams, insurance companies and Patient Financial Navigators to address insurance denials and manage appeals.
• Educates patients on insurance benefits, financial responsibility, and alternative coverage options.
• Provides updates on authorization status to clinical teams, oncologists, and Patient Financial Navigators.
• Maintains accurate records of authorization approvals, denials, and appeals.
• Ensures compliance with HIPAA, CMS regulations, and insurance guidelines.
• Stays updated on insurance policy changes, prior authorization trends, and oncology treatment protocols.
• Performs other duties as assigned

Qualifications:

• Education:
  
  High School Diploma or equivalent
• Experience:
  
  1-year relevant experience

e’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.

* Please note:

this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.