Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix. Our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today.

This role is accountable for all functions associated with CCS/Medic-Cal case acceptance to COH which includes family financial and medical screening of patients. Must have complete follow through for medial and financial eligibility and Center Care Authorization. Accountable for performing all functions, associated with the Utilization Review process for CCS/Medic-Cal cases in order to maximize reimbursement to the institution. Will over see the process for Outpatient Medi-Cal and CCS authorizations requests to make sure they are done in a timely and efficient manner.

As a successful candidate, you will:

• Completes CCS / Medi-Cal Referrals on all new pediatric patients and follows case until approved for CCS coverage.
• Monitors CCS cases and submits medical documentation to authorize services.
• Performs all Utilization Review for all CCS inpatient admissions, and assists with discharge planning and home health issues. Completes Medi-Cal inpatient TAR’s for utilization review, works with on-site Medi-Cal nurse to see that the TAR’s are completed and approved timely.
• Prepares all forms required by Medi-Cal and CCS for treatment authorization requests and extension.
• Works with Patient Business Services on Pending Medi-Cal cases to verify status of application and once the case is approved and/or denied makes sure the registration system is updated accurately.
• Assists Pediatric patient’s families with completion of Charity Care applications for and review for approval based on Charity Care Policy.
• Prepares and submits authorizations to Medi-Cal for off label drugs. Works with drug company assistance programs to cover off label drugs that will not be paid for by Medi-Cal.
• Handles all Medi-Cal disenrollments from HMO to Fee for Service.
• Assist with training of new staff on Medi-Cal and CCS regulations, and training of appropriate assignment of Plan/Carriers.
• Internal Contacts: Maintains a positive image when dealing with other departments, patients and physicians .
• External Contacts: Maintains a positive image when dealing with patients, patient’s family members, state agencies and insurance companies.
• Monitors the Outpatient authorization process to make sure the work is done accurately and notifies management of any problems related to this process.
• Follows established City of Hope and department policies, procedures, objectives, performance improvement, attendance, safety, environmental, and infection control guidelines, including adherence to the workplace Code of Conduct and Compliance Plan. Practices a high level of integrity and honesty in maintaining confidentiality.

Your qualifications should include:

• High School or equivalent Experience may substitute for minimum education requirements.
• Three to five years in related field and or/areas.
• Strong knowledge of Medi-Cal, CCS and third party program billing requirements, and patient billing process.
• Good understanding of government programs, authorizations and documentation.
• Preferably: Basic knowledge of how computer systems store/related data in files. Insurance billing requirements. Medical terminology knowledge of ICD-9, CPT-4 and HCPCS coding.

City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.

City of Hope is an equal opportunity employer. To learn more about our commitment to diversity, equity, and inclusion, please click here. To learn more about our Comprehensive Benefits, please CLICK HERE.