Financial Clearance Specialist - Hybrid

City of Hope; Irwindale (CA); Hybrid; USD 50,000 - 75,000; Full time

Job summary

City of Hope is hiring for a role focused on referral coordination, pre-registration, and patient services within a hybrid work model. The successful candidate will obtain authorizations, educate patients on insurance, and ensure accurate pre-registration and scheduling for oncologic care.

The position emphasizes strong communication and customer service, with duties spanning patient intake, insurer interactions, and coordination across care teams in a busy clinical environment.

Qualifications

• 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 registering patients and scheduling appointments; EPIC EMR experience.

Responsibilities

• Identifies insurance requiring prior authorization and obtains authorization for services.
• Educates patients about insurance policies and prepares required authorization materials for third parties.
• Pre-registers patients by verifying demographic, clinical and insurance information.
• Manages referrals, schedules, and coordinates with payors and departments to resolve issues.

Skills

Customer service

Communication

Education

High School Diploma or GED

Tools

EPIC EMR

Job description

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.

Hybrid Work Schedule. Mon - Fri. 8:30 - 5pm

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.