Medical Authorization Lead – Payer Approvals

University of Southern California; Los Angeles (CA); On-site; USD 36,000 - 56,000; Full time

Job summary

University of Southern California (USC) Care Medical Group seeks a Clinical Authorization Specialist to secure medical authorizations from third party payers for outpatient and inpatient services, including chemotherapy and infused treatments. You will interface with clinical staff and pharmacy to ensure timely authorizations and seamless patient care.

This role reports to the Administrative Clinic Manager and emphasizes documentation collection, tracking, and outcomes across the USC Care

Qualifications

• High school diploma or equivalent is required.
• 2 years of experience in a hospital, medical office, or with a health insurer.
• Excellent time management, organizational, research/analytical, negotiation, communication, and interpersonal skills.
• Ability to function independently and as part of a team.
• Demonstrated excellent customer service behavior.

Responsibilities

• Obtain written clinical documentation for ambulatory clinic authorizations in Keckcare.
• Submit pre-certification documentation to third party payers with correct CPT and ICD coding.
• Research payer medical policy requirements for authorizations and submission processes.
• Use Excel tracking log to document requests and report outcomes to the Supervisor daily.
• Follow up on outstanding authorization requests and medical documentation requests.
• Enroll patients in manufacturer patient assistance programs and follow up on enrollment/reimbursements.
• Communicate with medical/clinical/pharmacy staff and patients on authorization status/outcome.
• Use compliance checker for Medicare ambulatory authorizations and forward ABNS scans to front area for signatures.
• Coordinate with Director on denied or disputed claims to obtain supporting documentation.
• Maintain privacy and confidentiality when accessing medical records during authorization processing.
• Scan authorizations into Keck care under patient accounts and forward authorized orders to pharmacy when applicable.
• Maintain medical policy binders and update forms regarding medications and authorization requirements.
• Document authorization outcomes in all financial systems.
• Performs other duties as assigned.

Skills

Healthcare authorization experience

Payer communications

Documentation accuracy

Education

High school diploma or equivalent

Job description

University of Southern California (USC) Care Medical Group seeks a Clinical Authorization Specialist to secure medical authorizations from third party payers for outpatient and inpatient services, including chemotherapy and infused treatments. You will interface with clinical staff and pharmacy to ensure timely authorizations and seamless patient care.

This role reports to the Administrative Clinic Manager and emphasizes documentation collection, tracking, and outcomes across the USC Care