Clinical Authorization Specialist - Cardiovascular Medical Clinic - Full Time 8 Hour Days (Non-Exempt) (Union)

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 Ids 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 policys 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).

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin protected veteran status disability or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance and with due consideration for patient and student safety. Please refer to theBackground Screening Policy Appendix Dfor specific employment screen implications for the position for which you are applying.

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at or by email at. Inquiries will be treated as confidential to the extent permitted by law.

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