About City of Hope
City of Hope, an innovative biomedical research, treatment and educational institution with over 6000 employees, is dedicated to the prevention and cure of cancer and other life-threatening diseases and guided by a compassionate, patient-centered philosophy.
Founded in 1913 and headquartered in Duarte, California, City of Hope is a remarkable non-profit institution, where compassion and advanced care go hand-in-hand with excellence in clinical and scientific research. City of Hope is a National Cancer Institute designated Comprehensive Cancer Center and a founding member of the National Comprehensive Cancer Network, an alliance of the nation's leading cancer centers that develops and institutes standards of care for cancer treatment.
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Position Summary:
Under the general direction of a supervisor or manager, responsible for performing pre-registration functions and obtaining authorizations from various insurance carriers. This role requires a high level of independent judgement in order to successfully coordinate and obtain authorization requests for complex managed care patients in a timely and efficient manner. This individual is expected to utilize telecommunications and computer information systems to pre-register patients, verify information and insurance, and obtain authorizations. The Financial Clearance Specialist is best defined as a highly independent and flexible resource that focuses on system-specific service lines that are in alignment with the patient experience initiative. Furthermore, this role must multi-task between different patient care areas to ensure an extraordinary patient experience and that quality standards are met. Additional duties include, but are not limited to physician and patient communication serving as an information resource.
Key Responsibilities include:
Referral Coordination:
Identifies insurance companies requiring prior authorization for services and obtains authorization. Coordinates authorizations for procedures and testing requested by providers for their managed care patient. Reviews charts on outpatients and reports to third party payors. Retrieves chemo/surgery orders from chart, and requesting authorization through the insurance companies. Prepares all forms required by third party payor for treatment authorization requests. Work on all pending utilization review patients, and achieve authorization for the following day. Getting emergent authorizations from walk-in patients. Verifying with the insurance companies and documents what needs to be pre-certified.
Educates patient of their insurance policy. Composes letters and memoranda from physician dictation, or verbal direction for submission to insurance companies to obtain authorization or appeal denials. Maintains current records on managed care patients. Keeps Case Managers updated on all BMO and BMT patients.
Pre-Registration:
- Performs pre-registration functions prior to the patient appointment (including, but not limited to: obtains and/or verifies demographic, clinical, financial, insurance information, service eligibility, consent forms, and patient/guarantor information for pre-registered accounts).
- Contacts patients, payers, or other departments to confirm and verify insurance and demographic information. Refers patients to financial counselors to resolve insurance or payments issues.
- Identifies and resolves issues by working with patients, payors, and/or other CoH departments and personnel in a single interaction with the patient. Identifies patients with "share of cost" or co-payments by performing pricing estimations, and notifies patients of their expected patient liability and financial responsibility.
- Collects patient/guarantor liabilities and refers patients who are uninsured/underinsured to Financial Counselor for charity, financial assistance or governmental program screening and application processes.
- Notifies CoH contracting department of patients with a non-contracted insurance to prepare a Letter of Agreement (LOA) should patient to pursue services at COH and informs patient of approval status.
- Performs activities required to financial clearance for all patient types. Frequent communications will occur with patients/family members/guarantors, physicians/office staff, medical center and payors.
Customer Service:
- Ensure a high level of customer service by greeting, being a resource to patients and visitors. Serve as a liaison between patients and support staff. Develop effective relationships with colleague, physicians, providers, leaders and other employees across the organization. Demonstrates genuine interest in helping our patients, providers and other employees by using excellent communication skills, being polite, friendly, patient and calm under pressure. Managing multiple, changing priorities in an effective and organized manger, under stressful demand while maintaining exceptional service. Maintain composure when dealing with difficult situations and responding professionally. Independently recognize a high priority situation, taking appropriate and immediate action. Effectively communicates with service delivery and other departments to resolve issues that impact patient care and escalating issues that cannot be resolved in accordance with departmental guidelines. Answering daily phone calls and pages from doctors, patients, employees and insurance companies.
Quality Assurance:
- Maintains appropriate level of productivity and accuracy for work performed based on department standards. Maintains thorough knowledge of policies, procedures, and standard work within the department in order to successfully performance duties on a day-to-day basis.
Miscellaneous Duties:
Performs other departmental duties as assigned, such as answering and making phone calls, managing incoming/outgoing faxes, organizing and filing departmental documents, inventorying supplies, data entry, etc
Basic education, experience and skills required for consideration:
- High School Diploma.
- Three years related healthcare pre-registration/referral experience required. Medical terminology and electronic medical record experience required.
City of Hope is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.
- Posting Date: Nov 29, 2021
- Job Field: Business Services
- Employee Status: Regular
- Shift: Day Job