Clinical Authorization Specialist - USC Cancer Center LA - Full Timed 8 Hour Days (Non-Exempt) (Non-Union)

University of Southern California•Los Angeles, CA

7d•$26 - $41

About The Position

The Clinical Authorization Specialist secures medical authorizations from commercial and government third-party payers for outpatient clinic services, inpatient admissions, ancillary services, chemotherapy and other infused treatments, and other requested procedures in the assigned service line. The Specialist obtains and submits supporting clinical documentation, tracks authorization requests, reports and documents outcomes, and works directly with medical and clinical staff, pharmacy, and patients to help ensure a seamless treatment process. This role supports the Koreatown/Buena Park Medical Oncology/Multi-Disciplinary Clinic and reports to the Administrative Clinic Manager. The position is full-time, with 8-hour days, and is non-exempt and non-union.

Requirements

High school diploma or equivalent, or equivalent evidence in file.
Two years of experience in a hospital, medical office/doctor’s office, or working for a health insurer.
Excellent time-management, organizational, research and analytical, negotiation, written and verbal communication, and interpersonal skills.
Ability to function independently and as a member of a team.
Demonstrated excellent customer service behavior.
Fire Life Safety Training (LA City); if the employee does not have a card upon hire, it must be obtained within 30 days of hire and maintained through renewal before expiration. Required within LA City only.

Nice To Haves

Experience in the area of service.
Medical prior authorization or claims experience in a managed care setting.
Ophthalmic experience.
Knowledge of medical terminology.
Knowledge of the health insurance industry and claims processing.

Responsibilities

Obtain written clinical documentation from medical and nursing staff for ambulatory clinic consultations and examinations, OT/PT, procedures, and treatments for authorization submissions in Keckcare.
Submit pre-certification and pre-determination documentation to third-party payers or insurance carriers with correct CPT and ICD coding.
Research payer medical policy requirements and understand submission processes for authorization requests.
Use an Excel tracking log to document authorization requests, follow up on outstanding items, and provide outcomes to the Supervisor daily before the end of the shift.
Follow up promptly on pending authorization requests and requests for medical documentation.
Enroll patients in manufacturer patient assistance programs as needed and follow up on enrollment and medication reimbursements.
Communicate authorization status and outcomes to medical, clinical, and pharmacy staff, as well as patients.
Use the compliance checker for Medicare-eligible services and scan or email ABNS to front-area reception for signatures as needed.
Coordinate with the Director on denied or disputed claims and obtain supporting documentation.
Protect patient privacy and confidentiality while accessing medical records to process authorization requests.
Scan authorizations into Keckcare under the appropriate patient accounts and, when applicable, forward authorized orders to the pharmacy for dispensing.
Maintain the medical policy coverage binder and update it with new policies and forms related to FDA-indicated medication use and authorization requirements.
Document authorization outcomes in all financial systems.
Perform other duties as assigned.