Financial Clearance Specialist
US-ID-Boise
careers
Req #: 102255
Type: Full-Time
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Overview: 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. What You Can Expect: 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: 1 year relevant experience Responsibilities: 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: 1 year relevant experience Licenses/Certifications: None
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