St. Luke's Health System · 1 day ago
Specialty Financial Clearance Rep - 141048
Boise, ID
Full-time
Onsite
Entry Level
1+ years expSt. Luke's Health System is dedicated to fostering a supportive workplace culture and providing excellent patient care. The Specialty Financial Clearance Specialist is responsible for securing prior authorizations for oncology treatments and coordinating with various stakeholders to ensure timely patient care while navigating insurance complexities.
Health CareHospitalNon ProfitPrimary and Urgent Care
Responsibilities
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
Qualification
Required
Education: High School Diploma or equivalent
Experience: 1-year relevant
Benefits
Robust benefits package
Competitive salary
Retirement plans
Medical, dental, and vision offerings
On-site massages
On-site counseling via our Employee Assistance Program
Access to the Personify Health Wellness tool
Formal training and career development offerings
Company
St. Luke's Health System
St. Luke's Health System is a healthcare facility offering internal medicine and urgent care services.
10001+ employees
H1B Sponsorship
St. Luke's Health System has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (4)
2024 (9)
2023 (7)
2022 (1)
2021 (7)
2020 (3)
Funding
Current Stage
Late StageLeadership Team
Kate Fowler, FACHE, CPA
SVP, Chief Financial Officer
Dani Jones, M.Coun
Chief Operating Officer, Health Partners
Recent News
HealthCareIT News
2025-11-21
Company data provided by crunchbase