Financial Clearance Specialist - OC

City of Hope Orange County is transforming cancer treatment by bringing world-class expertise and specialized care closer to home. Supported by a regional network of care, our 11-acre academic cancer campus in Irvine is home to City of Hope Orange County Lennar Foundation Cancer Center, our outpatient cancer center, and Orange County's only cancer specialty hospital, opening in late 2025.

With the opening of the hospital, the full continuum of advanced cancer care-from prevention through survivorship-will be available in Orange County for the first time, eliminating the need to travel for lifesaving treatment. Seamlessly connected to our outpatient cancer center, the new clinical research hospital will feature 73 inpatient beds, advanced surgical suites, groundbreaking clinical trials, and holistic services such as rehabilitative therapy and spiritual care. This isn't standard cancer care. This is lifesaving cancer care. This is Hope.

As a successful candidate, you will:

Referral Coordination

• 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/surgery 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.

Pre-Registration

• 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.

Customer Service

• 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.

Your qualifications should include:

• High School Diploma or equivalent GED.
• Three years related healthcare pre-registration/referral experience required.
• Medical terminology and electronic medical record experience required.
• Preferably: At least two years front desk oncology practice experience registering patients and scheduling appointments. EPIC EMR experience

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 Comprehensive Benefits, please CLICK HERE.