Job Details

Day to day:

Our client is looking for a Financial Clearance Representative to support their growing CAP team. This position supports the Authorizations Team responsible for obtaining service authorizations for patients seen at City of Hope clinics across multiple states and cities (3 clinics, possibly expanding to 4, in Arizona, 2 Clinics in Chicago, and 1 clinic in Atlanta). The current team size is 6 members, but looking to eventually expand to 12 team members. This person will be working with all types of insurance plans: HMOs, PPOs, Medi-Cal, Medicare, etc. across the given states. This person will need to quickly become familiar with the different plan types for the different locations. This practice uses Epic EMR system, and training will be provided. There will be City of Hope Training modules, once completed will participate in 1 on 1 training with the team lead, then transition to independent work once the team member feels comfortable. High volume of radiology and chemotherapy authorizations, as City of Hope specializes in oncology treatment and research.

Key Responsibilities:

• Process and submit authorizations for services ordered by providers after patient visits.
• Verify insurance eligibility for all scheduled patients on a monthly basis.
• Monitor and manage two primary work queues: Patient Queue – Insurance verification and registration updates and Referral Queue – Authorization and order submissions.
• Look up registration errors, update insurance/registration errors and details, and complete data entry tasks.
• Work through queues by appointment date or expected future date, ensuring all tasks are completed thoroughly before moving to the next patient.

Must Haves:

• 2-3+ years of experience with insurance verification, authorizations, and referrals
• High School diploma or GED
• Strong understanding of medical terminology
• Experience in clinical medical setting

Plusses:

• Experience with oncology, radiology, chemotherapy, or any other specialties
• Experience working as a medical assistant
• Experience with Epic EMR system