Financial Counselor - OC Hospital

City of Hope; Irvine (CA); On-site; USD 60,000 - 90,000; Full time

Job summary

City of Hope in California is seeking a dedicated coordinator to manage CCS/Medi-Cal case acceptance and the related medical and financial screening for pediatric patients. The role ensures timely authorizations, accurate documentation, and compliance with CCS, Medi-Cal, and third-party billing requirements.

You will oversee the utilization review process, assist with discharge planning, and collaborate with Patient Business Services to verify approvals and update registration.

Qualifications

• High school diploma or equivalent required.
• 3–5 years in medical billing or related field.
• Strong knowledge of Medi-Cal, CCS, and third‑party billing.
• Understanding of government programs and documentation.
• Basic computer and data filing skills; ICD-9, CPT-4 coding knowledge.

Responsibilities

• Process CCS/Medi-Cal referrals for new pediatric patients.
• Monitor CCS cases and document status for authorization.
• Perform Utilization Review for CCS inpatient admissions.
• Prepare Medi-Cal and CCS forms for treatment authorizations.
• Coordinate with Patient Business Services on Medi-Cal cases.
• Assist with Charity Care applications and approvals.
• Submit Medi-Cal authorizations for off-label drugs.
• Support training of new staff on Medi-Cal regulations.
• Maintain professional interactions with patients and departments.

Skills

Medi-Cal Billing

CCS Billing

Third-Party Billing

Utilization Review

Medical Terminology

EMR Systems

Education

High School Diploma or equivalent

Tools

EMR Systems

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.

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 medical 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.

Work Schedule: Monday - Friday from 8:30 - 5pm PT

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 dis-enrollments 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 and 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.

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.