Insurance Specialist

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.

To verify insurance policy benefit information and obtain authorizations/pre-certifications for services. To determine if patient's insurance is acceptable according to institutional guidelines and to obtain authorizations and pre-certifications.

• Verifies hospital and professional insurance policy benefits for new and return patients. The verification process includes: Telephone contact, Mail/Facsimile, On-line inquiry
• Where possible, prorates bill estimate for multiple payors to identify self pay liability (Uses coordination of benefits where applicable).
• Works in coordination with the referral nurses, case managers, financial counselors, to obtain treatment authorizations and pre-certifications through the insurance company and/or the primary care physician.
• Enters information concerning the policy benefits into the system. Updates insurance information in the system.
• Receives and reads COHMNC managed care contracts summaries to obtain an understanding of the contract provisions and interprets for insurance coverage. Acts as resource regarding managed care contract changes and updates.
• Works with referral, financial support services, admitting, registration and clinics personnel to develop sound financial arrangements.
• Investigates and/or ensures that questions and requests for information are responded to in a timely and pro¬fessional manner to ensure resolution of outstanding accounts.
• Prepares daily and weekly productivity statistics for management review.
• Identifies opportunities for improvement in customer service or insurance company interactions.
• Refers issues to supervisors or other staff for review of denials.
• Assist case managers, UR nurses, etc., in appealing denials.
• Participates in meetings with insurance carrier representatives.
• Other duties as assigned by supervisor.
  

Basic education, experience and skills required for consideration:

• High School Diploma.
• Sixty Hours of College.
• Experience may substitute for minimum education requirements.
• One year business experience or interaction with the public.
• Two or more years experience in insurance related tasks with hospital and/or physician office practices.
  

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.