Job Description
Authorization Appeals Specialist
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, andtreatment facilitiesin 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.
The successful candidate:
The Authorization Denials Specialist is responsible for review and resolution of authorization denials; primary responsibilities include:
Day to day processing of authorization denials, investigating denial reason, review of the prior authorization notes and insurance requirements related to the claim, completing retro authorizations if available, maintaining a record of action taken and monitoring the compliance timeframe requirements from various insurance plans
Demonstrating the ability to assess the root cause of the denial in accordance with established criteria
Assists with identifying areas of denial trends and mitigation opportunities
Works closely with departments outside of Clinical Appeals that impact denials when needed
Maintaining proficiency in all technology, applications, payer policies, guidelines and requirements related to Precertification/ Authorizations
Minimum Job Qualifications
Education: High School Diploma or GED
Experience: 1-3 years related work experience
Knowledge, Skills, Abilities:
Understanding of Authorization requirements within a provider organization.
Understanding of financial reimbursement and revenue cycle operations in a provider organization.
Basic understanding of CPT, ICD Coding, Insurance and Medical Terminology, HIPAA
Strong organizational and communication skills
Efficient in prioritizing and managing workload with minimal oversight
Preferred Attributes
Associates Degree
Experience in prior authorization role
City of Hope is an equal opportunity employer. To learn more about our commitment to diversity, equity, and inclusion, please click here.
To learn more about our comprehensive benefits, click here:Benefits Information
Salary / Pay Rate Information:
Pay Rate: $20.95 - $34.52 / hour
The estimated pay scale represents the typical [salary/hourly] range City of Hope reasonably expects to pay for this position, with offers determined based on several factors which may include, but not be limited to, the candidate’s experience, expertise, skills, education, job scope, training, internal equity, geography/market, etc. This pay scale is subject to change from time to time.
City of Hope is a community of people characterized by our diversity of thought, background and approach, but tied together by our commitment to care for and cure those with cancer and other life-threatening diseases. The innovation that our diversity produces in the areas of research, treatment, philanthropy and education has made us national leaders in this fight. Our unique and diverse workforce provides us the ability to understand our patients' needs, deliver compassionate care and continue the quest for a cure for life-threatening diseases. At City of Hope, diversity and inclusion is a core value at the heart of our mission. We strive to create an inclusive workplace environment that engages all of our employees and provides them with opportunities to develop and grow, both personally and professionally. Each day brings an opportunity to strengthen our work, leverage our different perspectives and improve our patients’ experiences by learning from others. Diversity and inclusion is about much more than policies and campaigns. It is an integral part of who we are as an institution, how we operate and how we see our future.
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