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.
Position Overview:
This role is responsible for all functions related to CCS/Medicaid case acceptance at COH, including family financial and medical screening of patients. The incumbent must ensure complete follow-through for medical and financial eligibility and Center Care Authorization. Additionally, the role involves performing all functions associated with the Utilization Review process for CCS/Medicaid cases to maximize reimbursement. Oversight of outpatient Medi-Cal and CCS authorization requests is also required to ensure timely and efficient processing.
Work Schedule: Monday - Friday, 8:30 AM - 5:00 PM PT
Key Responsibilities:
- Complete CCS / Medi-Cal referrals for all new pediatric patients and monitor cases until approved for CCS coverage.
- Monitor CCS cases and submit medical documentation to authorize services.
- Perform utilization reviews for all CCS inpatient admissions, assist with discharge planning, and coordinate home health issues. Complete Medi-Cal inpatient TARs and collaborate with on-site Medi-Cal nurses for timely approval.
- Prepare all forms required by Medi-Cal and CCS for treatment authorization requests and extensions.
- Coordinate with Patient Business Services to verify the status of Medi-Cal applications and update registration systems accordingly.
- Assist families of pediatric patients with completing and reviewing Charity Care applications based on the Charity Care Policy.
- Prepare and submit authorizations to Medi-Cal for off-label drug use, and work with assistance programs to cover drugs not paid for by Medi-Cal.
- Handle Medi-Cal disenrollments from HMO to Fee-for-Service.
- Assist in training new staff on Medi-Cal and CCS regulations and appropriate plan/carrier assignments.
- Maintain positive internal and external relationships with departments, patients, families, state agencies, and insurance companies.
- Monitor outpatient authorization processes for accuracy and report issues to management.
- Adhere to City of Hope policies, procedures, safety, and compliance guidelines, maintaining confidentiality and integrity.
- Perform other duties as assigned.
Qualifications:
- High School diploma or equivalent; experience may substitute for education.
- 3-5 years in a related field.
- Strong knowledge of Medi-Cal, CCS, third-party billing, and patient billing processes.
- Understanding of government programs, authorizations, and documentation.
- Preferred: Basic knowledge of computer systems, insurance billing requirements, and medical coding (ICD-9, CPT-4, HCPCS).
City of Hope employees' pay is based on experience, qualifications, and work location. City of Hope is an equal opportunity employer. For more details on our comprehensive benefits, please CLICK HERE.
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