Principal Admitting Worker

Avispa Technology•San Francisco, CA

1d•Onsite

About The Position

A leading medical institution is seeking a Principal Admitting Worker to support high-volume authorization workflows. This role is responsible for securing treatment authorizations, managing complex accounts, and ensuring compliance with Medi-Cal and multi-payer requirements while working independently in a fast-paced environment.

Requirements

3+ years of clerical experience, including 2+ years at an Admitting Worker level or comparable role.
5+ years of hands-on experience in authorization, financial clearance, or utilization review, with CCS authorization as a primary responsibility.
Strong knowledge of Medi-Cal, CCS guidelines, government programs, and coordination of benefits across multiple payers.
Proficiency with EPIC or APeX systems and experience managing authorization workflows and documentation.
Experience in submitting SARs and working directly with CCS across multiple counties.
ADT experience.
Basic medical terminology knowledge and typing/computer proficiency (including PC systems and office tools).

Responsibilities

Manage end-to-end CCS authorization workflows, including submitting Service Authorization Requests (SARs), coordinating with all California CCS counties, and securing approvals for inpatient and outpatient services.
Perform detailed account analysis by verifying patient demographics, clinical information, insurance eligibility, benefits, and coordination of benefits across complex multi-payer scenarios.
Handle high-volume authorization workloads, including follow-ups, denials, escalations, and resolution of coverage issues while meeting financial and operational targets.
Collaborate with case managers, providers, and external stakeholders, including CCS offices and medical directors, to resolve authorization and billing issues.
Maintain accurate documentation and workflow management within EPIC/APeX systems while ensuring compliance with Medi-Cal, CCS guidelines, and regulatory requirements.