About City of Hope

City of Hope's mission is to deliver the cures of tomorrow to the people who need them today. Founded in 1913, City of Hope has grown into one of the largest cancer research and treatment organizations in the U.S. and one of the leading research centers for diabetes and other life-threatening illnesses. City of Hope research has been the basis for numerous breakthrough cancer medicines, as well as human synthetic insulin and monoclonal antibodies. With an independent, National Cancer Institute-designated comprehensive cancer center at its core, City of Hope brings a uniquely integrated model to patients spanning cancer care, research and development, academics and training, and innovation initiatives. 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. City of Hope's affiliated group of organizations includes Translational Genomics Research Institute and AccessHopeTM. For more information about City of Hope, follow us on Facebook, Twitter, YouTube, Instagram and LinkedIn.

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

Huntington Beach, CA Location

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.

Key Responsibilities include:

• 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.
• Performs other related duties as assigned or requested.

Basic education, experience and skills required for consideration:

• 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.

Preferred education experience and skills:

• Good understanding of government programs, authorizations and documentation
• 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

Additional Information:

The estimated pay scale represents the typical [salary/hourly] range City of Hope reasonably expects to pay for this position, with offers determined based on several factors which may include, but not be limited to, the candidate's experience, expertise, skills, education, job scope, training, internal equity, geography/market, etc. This pay scale is subject to change from time to time.

As a condition of employment, City of Hope requires staff to comply with all state and federal vaccination mandates.

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.

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