Description
The Clinical Authorization Specialist will take the lead in securing medical authorizations from third party payers. The Specialist will be instrumental in obtaining written documentation, submitting tracking, reporting and documenting outcomes of each authorization request. The Specialist will be in a position to interface directly with medical/clinical staff and pharmacy to ensure a seamless process to the patients receiving treatment.
The Clinical Authorization Specialist will take the lead in securing medical authorizations from third party payers (commercial and government) for outpatient clinic, inpatient admission, ancillary services and/or chemotherapy and other infused treatments as needed. The Specialist will be instrumental in obtaining written documentation, submitting tracking, reporting and documenting outcomes of each authorization request. The Specialist will be in a position to interface directly with medical/clinical staff and pharmacy to ensure a seamless process to the patients receiving treatment.
Essential Duties:
- Generate a patient MRN (Medical Record Number)and is adept at utilizing the MRN checker.
- Patient identifier is “Name and date of birth” to assure you are registering the correct patient.
- Demonstrates ability to maintain confidentiality of patient information.
- Determine if the patients insurance is contracted with USC.
- Edit insurance information as appropriate.
- Resolve all GE Centricity Alerts.
- Assure all documents are obtained signed and scanned or available in the EMR a. Insurance Card b. Identification Card c. Condition of Service – hospital document d. Financial Responsibility- Physician document e. Notice of Privacy Practices-
- Obtain patient demographics confirm all are current and correct in both hospital and physician systems.
- Utilize appropriate a. Financial Class b. Plan Id's c. Service Code d. Patient type
- Ability to verify and comprehend insurance benefits via: a. Contacting insurance companies directly b. Electronic verification system (Ecommerce or Passport or direct insurance websites) c. Ensure effective dates and co-pays are documented in registration systems
- In Physician System Utilize appropriate a. FCS b. Alternate Insurance
- Assuring authorizations are in place as specified by patients carrier
- Customer service skills: a. Phone etiquette b. Scripting as provided by supervisor/management c. Escort patients as needed d. Professional conduct when speaking to patients and co-workers and Physicians
- Ability to request patient financial liabilities (Co-pay outstanding balances)
- Follow and adhere dress code attendance policy's provided by Human Resources
- Assist Supervisor as needed with special projects and other duties as assigned a. Scheduling b. Break and or Lunch coverage c. Check out d. Any other duties assigned by your supervisor
- Balances cash drawer to Batch.
- Closes out batches.
- Prepare bank deposit for Physician practice.
- Perform other duties as assigned.
Required Qualifications:
- Req High school or equivalent Or equivalent evidence in file.
- Req 1 year Hospital experience or in a related field.
- Req Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills
- Req Able to function independently and as a member of a team.
- Req Demonstrate excellent customer service behavior.
Preferred Qualifications:
- Pref Knowledge of medical terminology.
- Pref Knowledge of the health insurance industry and claims processing.
Required Licenses/Certifications:
- Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only).
The hourly rate range for this position is $23.00 - $39.10. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
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