St. Luke's Health System

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:

Under minimal supervision, the Specialty Financial Clearance Specialist Lead serves as the subject matter expert and primary point of escalation for securing prior authorizations for complex oncology treatments. This role provides leadership in optimizing oncology treatment authorization workflows, training team members, and ensuring compliance with payer requirements to prevent treatment delays. The Lead collaborates closely with providers, clinical teams, insurance carriers, pharmacy teams, and patients while driving operational improvements to streamline the oncology authorization process. 

• Serves as the lead resource and oversees daily barriers for the oncology authorization team. 
• Content expert in securing prior authorizations for high-dollar and complex oncology treatments, including chemotherapy, immunotherapy, radiation, gene therapy, stem cell transplants, targeted radiation therapies, specialty labs, and oncology procedures.
• Oversees daily authorization workflows, ensuring timely and accurate submissions, tracking, and follow-ups to minimize delays in patient care. 
• Develops and delivers training programs for new and existing staff, ensuring proficiency in oncology authorization processes, medical necessity guidelines, and payer-specific requirements. 
• Identifies trends in payer policies and authorization denials, proactively working with leadership to implement process improvements and best practices. 
• Collaborates with providers, pharmacy teams, clinical documentation specialists, coders, and insurance carriers to resolve complex authorization issues and appeals, including coordination of peer-to-peer reviews and external reviews when necessary.
• Advocates for patients by assisting in securing financial assistance, providing education on insurance coverage, out-of-pocket costs, and alternative funding options. 
• Leads initiatives to improve authorization turnaround times, reduce denials, and enhance communication between stakeholders, ensuring compliance with insurance guidelines, HIPAA, and CMS regulations. 
• Stays current on evolving oncology treatments, insurance policies, and medical necessity requirements, disseminating critical updates to the team and clinical stakeholders. 
• Serve as SME & at times carries an authorization workload 
•  Other duties and responsibilities as assigned.

Qualifications:

• Education: High school diploma or equivalent
• Experience: 3 years relevant experience

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.

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