About City of Hope
City of Hope is an independent biomedical research and treatment organization for cancer, diabetes and other life-threatening diseases.
Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR T cell therapy. City of Hope's translational research and personalized treatment protocols advance care throughout the world. Human synthetic insulin, monoclonal antibodies and numerous breakthrough cancer drugs are based on technology developed at the institution. AccessHope™, a subsidiary launched in 2019 serves employers and their health care partners by providing access to City of Hope's specialized cancer expertise.
A National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City of Hope is ranked among the nation's "Best Hospitals" in cancer by U.S. News & World Report and received Magnet Recognition from the American Nurses Credentialing Center. Its main campus is located near Los Angeles, with additional locations throughout Southern California and in Arizona.City of Hope's commitment to Diversity, Equity and Inclusion
We believe diversity, equity and inclusion is key in serving our mission to provide compassionate patient care, drive innovative discovery, and advance vital education focused on eliminating cancer and diabetes in all of our communities. Our commitment to Diversity, Equity and Inclusion ensures we bring the full range of skills, perspectives, cultural backgrounds and experiences to our work -- and that our teams align with the people we serve in order to build trust and understanding. We are dedicated to fostering a community that embraces diversity - in ideas, backgrounds and perspectives; this is reflected in our work and represented in our people.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:
- 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 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.
- 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.
- 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.
- 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.
- 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:
Preferred education experience and skills:
- High School Diploma.
- Three years related healthcare pre-registration/referral experience required.
- Medical terminology and electronic medical record experience required.
- EPIC EMR
- At least two years front desk oncology practice experience registering patients and scheduling appointments
- As a condition of employment, City of Hope requires staff to comply with all state and federal vaccination mandates.
- This position is represented by a collective bargaining agreement
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.