Financial Clearance Specialist

St. Luke's Health System•Boise, ID

23h

About The Position

The Financial Clearance Specialist supports a seamless patient experience by verifying financial eligibility, securing prior authorizations, providing price transparency, and facilitating accurate financial clearance before medical services. The role works with patients, insurance companies, registration and billing team members, and clinical and hospital staff to ensure patients are financially cleared and to collect payments toward deductibles and co-insurance. Under general supervision, the specialist resolves typically straightforward issues and escalates more complex problems to senior levels. Other duties may be assigned as required.

Requirements

High school diploma or GED.
One year of relevant experience.

Responsibilities

Obtain prior authorizations and referrals from insurance companies, including submitting medical records and authorization documentation.
Create patient liability estimates based on plan policies and benefits, explain patients’ financial responsibilities, and collect payments toward out-of-pocket costs.
Validate the accuracy of CPT codes associated with procedures.
Verify patients’ insurance coverage, including multiple payer and government-payer coverage.
Verify co-pays, deductibles, and out-of-pocket patient responsibility.
Coordinate with medical staff to support timely and accurate financial clearance, including peer-to-peer reviews and obtaining medical record documentation for insurance companies.
Keep patients and family members informed about prior-authorization status.
Generate and deliver notices for non-covered services and refer patients to possible financial assistance when necessary.
Monitor payer network status and communicate status to patients; initiate gap authorization and single-case agreement workflows when appropriate.
Accurately document financial clearance activities in the patient’s electronic health record (EHR).
Confirm that the provider associated with a procedure is credentialed with the payer.
Respond to emails and phone calls from patients and staff requesting cost estimates.
Escalate complex problems to senior levels and perform other duties as required.