Medi-Cal & CCS Authorization Specialist

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

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.