Medical Authorization Lead: Payer Approvals & Access

University of Southern California; Los Angeles (CA); On-site; USD 36,000 - 57,000; Full time

Job summary

USC Care Medical Group in Los Angeles seeks an experienced Clinical Authorization Specialist to lead the procurement of medical authorizations from third-party payers for outpatient, inpatient, and ancillary services including chemotherapy. You will work closely with clinical staff and pharmacy to ensure a seamless patient experience.

The role emphasizes obtaining documentation, submitting, tracking, and reporting authorization outcomes, while maintaining patient privacy.

Qualifications

• High school diploma or equivalent required.
• 2 years experience in a hospital/medical setting or health insurer.
• Excellent time management, organizational, research/analytical, negotiation and communication skills.
• Ability to work independently and as part of a team.
• Strong customer service orientation.

Responsibilities

• Obtain written clinical documentation for ambulatory and other treatment authorizations.
• Submit pre-certification documents to payers with correct CPT/ICD codes.
• Research payer policies for authorization requirements.
• Maintain Excel tracking log and report outcomes to supervisor daily.
• Follow up on outstanding authorization requests and documentation needs.
• Assist in enrolling patients in manufacturer patient assistance programs and track reimbursements.
• Communicate authorization status with medical staff and patients.
• Coordinate with director on denied or disputed claims and gather supporting documentation.
• Ensure privacy and confidentiality when accessing medical records and processing authorizations.

Skills

Time management

Organizational skills

Research skills

Negotiation

Communication

Interpersonal skills

Independent work

Team player

Customer service

Education

High school diploma or equivalent

Job description

USC Care Medical Group in Los Angeles seeks an experienced Clinical Authorization Specialist to lead the procurement of medical authorizations from third-party payers for outpatient, inpatient, and ancillary services including chemotherapy. You will work closely with clinical staff and pharmacy to ensure a seamless patient experience.

The role emphasizes obtaining documentation, submitting, tracking, and reporting authorization outcomes, while maintaining patient privacy.