Lead Pre-Encounter/Financial Clearance Representative

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The Lead Financial Clearance Representative performs all of the job responsibilities of a Pre-Encounter Representative Level II. Responsible for the integrity of patient, financial and verification data obtained by staff and notification of deficiencies to staff and management. In the absence of management, the Lead will be the individual that staff/other departments will contact if there are questions or issues to resolve. Responsible to resolve when appropriate, notify management of the issue and/or escalate to management for resolution.

JOB DUTIES AND RESPONSIBILITIES:

Responsible for the financial clearance of all scheduled patients by providing accurate and timely verification of all financial information and pre-certification/referral for all services to ensure proper reimbursement

Monitors all schedules to insure that all cases are identified and financial clearance is obtained.

Ensures that either pre-certifications or referrals are obtained prior to date of service (i.e. Surgery, diagnostic studies and infusion services).

Verifies benefits and coverage. Refers all self pay patients to the Financial Navigators for payment and accessibility options

Ensures CPT codes coordinate with testing and procedures that are ordered. Obtains retro authorizations and prepares appeals for denied services.

Updates and/or communicates correct patient information to appropriate staff, hospital departments, and computer systems

Identifies communication and procedural inefficiencies and/or breakdowns among staff and other departments or areas and assist in developing a correction plan. Provides information regarding process and reimbursement changes to providers, patients and other departments

Maintains ongoing knowledge of billing regulations and/or requirements and registration procedures

Serves as preceptor for all education in the department. Monitors and audits case record for appropriate resolution

Serves as “Go to” person for Supervisor and Manager during daily operations.

EDUCATION:

High School Graduate or equivalent

TRAINING AND EXPERIENCE:

Three (3) years healthcare experience in an outpatient department or business office with a hospital, physician’s office, or similar medical facility required. Strong customer service skills with knowledge of health insurance coverage and plans. Must have ability to work independently. Computer experience required. Bilingual preferred

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!

St. Luke's University Health Network is an Equal Opportunity Employer. (http://www.slhn.org/EOE)

Founded in 1872, St. Luke’s University Health Network (http://www.slhn.org/) (SLUHN) is a fully integrated, regional, non-profit network of more than 20,000 employees providing services at 15 campuses and 300+ outpatient sites. With annual net revenue of $3.5 billion, the Network’s service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Luke’s hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Luke’s Children’s Hospital.

SLUHN is the only Lehigh Valley-based health care system to earn Medicare’s five-star ratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and Healthgrades Top Hospital and a Newsweek World’s Best Hospital. The Network’s flagship University Hospital has earned the 100 Top Major Teaching Hospital designation from Fortune/Merative 11 times total and eight years in a row, including in 2023 when it was identified as THE #4 TEACHING HOSPITAL IN THE COUNTRY. In 2021, St. Luke’s was identified as one of the 15 Top Health Systems nationally.

SLUHN has been named a Top Workplaces 2023 by the Morning Call. In addition, St. Luke’s has been named a Top Workplace nationally, in the Philadelphia region, and in New Jersey. St. Luke’s is the ONLY healthcare institution in Pennsylvania and the third-highest ranked healthcare entity in the nation to be deemed a Top Workplace in 2023. In 2023, St. Luke’s was named one of America’s Best Employers for Women by Forbes. St. Luke’s was the only employer in the Lehigh Valley to be named to the list and was one of only two healthcare employers in Pennsylvania to receive the designation. St. Luke’s University Health Network is the top-ranked Lehigh Valley-based employer in Forbes Magazine’s ranking of employers in Pennsylvania.

Learn More Here. (http://www.slhn.org/About)