Clinical Authorization Specialist (Hospital) - PreArrival - Full Time 8 Hour Days (Non-Exempt)

Clinical Authorization Specialist (Hospital) – PreArrival – Full Time 8 Hour Days (Non-Exempt) (Non-Union). Location: Los Angeles, CA. Responsibilities Actively obtain written clinical documentation for chemotherapy authorizations in Keckcare for authorization submission from Medical/Nursing Staff. Submit pre‑certification / pre‑determination documentation to third‑party payers / insurance carriers for authorization with correct CPT and ICD coding. Research payer medical policy requirements for chemotherapy treatment authorizations and understand processes for submitting pre‑certification / pre‑determination requests. Utilize Excel Macro tracking log to document authorization requests, follow‑up on items and provide outcomes to the Supervisor daily, prior to end of shift. Follow‑up on outstanding authorization requests and on medical documentation requests in a timely manner. Enroll patients in manufacturer patient assistance programs as needed and follow‑up regarding enrollment and / or medication reimbursements. Communicate with medical / clinical / pharmacy staff and patients on authorization status / outcome. Employ compliance checker for Medicare‑eligible chemotherapy / infusion treatment authorizations and scan / email ABNS to front area reception for signatures as needed. Coordinate with Director on denied or disputed claims to obtain documentation to support chemotherapy treatment. Exhibit sensitivity to patients at all times concerning privacy and confidentiality while accessing medical records for chemotherapy treatments to process authorization requests. Scan all authorizations into Keck care under the respective patient accounts and if applicable, forward authorized orders to pharmacy for dispensing. Maintain medical policy coverage binder and keep updated with new policies and forms regarding medications, FDA‑indicated usage and authorization requirements. Document authorization outcome in all financial systems. Perform other duties as assigned. Required Qualifications High school diploma or equivalent evidence in file. Two (2) years of experience in a hospital, medical office / doctor’s office or working for a health insurer. Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills. Preferred Qualifications Specialized/technical training Vocational Nursing Degree. Oncology experience preferred. Medical prior authorizations or claims experience in a managed care setting highly preferred. Knowledge of the health insurance industry and claims processing a plus. Licensed Vocational Nurse – LVN (CA DCA). Required Licenses / Certifications 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. Compensation The hourly rate range for this position is $25.00 - $39.69. Factors considered in offer include scope and responsibilities, experience, education / training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, and external market and organizational considerations. #J-18808-Ljbffr Veterans in Healthcare