Strategic Medical Authorization Lead

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

Job summary

The University of Southern California is seeking a Clinical Authorization Specialist to lead securing medical authorizations from third party payers for outpatient, inpatient, chemotherapy and other procedures. You will obtain written documentation, submit tracking, report outcomes, and coordinate with medical staff and pharmacy to ensure a seamless patient care process.

The role reports to Administrative Clinic Manager and supports Keck Medicine of USC across multiple clinics, with emphasis on

Qualifications

• High school diploma or equivalent required.
• 2 years experience in hospital/medical office or health insurer.
• Excellent time management, organizational, research/analytical, negotiation, communication and interpersonal skills.

Responsibilities

• Actively obtain written clinical documentation for ambulatory clinic consultations and other authorizations.
• Submit pre-certification and pre-determination documentation with correct CPT/ICD coding.
• Research payer medical policy requirements for authorizations and submission processes.
• Maintain Excel tracking log and report outcomes to Supervisor daily.
• Follow-up on outstanding authorization requests and on medical documentation requests.
• Enroll patients in manufacturer patient assistance programs as needed and follow-up on enrollment and reimbursements.
• Communicate authorization status with medical staff and patients.
• Coordinate with Director on denied or disputed claims to obtain supporting documentation.
• Ensure privacy of patient records in accordance with regulations and scan/forward signed authorizations.

Skills

Time management

Organizational skills

Research/analytical skills

Negotiation

Communication

Interpersonal skills

Independent work

Teamwork

Customer service

Education

High school diploma or equivalent

Tools

Excel

Job description

The University of Southern California is seeking a Clinical Authorization Specialist to lead securing medical authorizations from third party payers for outpatient, inpatient, chemotherapy and other procedures. You will obtain written documentation, submit tracking, report outcomes, and coordinate with medical staff and pharmacy to ensure a seamless patient care process.

The role reports to Administrative Clinic Manager and supports Keck Medicine of USC across multiple clinics, with emphasis on