Current jobs related to Clinical Authorization Specialist - Los Angeles - Keck Medical Center of USC
-
Authorization Specialist
3 weeks ago
Los Angeles, United States Tarzana Treatment Center Full timeJob DescriptionJob DescriptionPosition Title:Authorization Specialist IIDepartment: Quality Assurance Reports To: QA SupervisorPOSITION SUMMARYUnder the general supervision of the Quality Assurance Supervisor, the Authorization Specialist focuses on managing contract patient authorization status issues. This position is also responsible for reporting on...
-
Authorization Specialist
4 weeks ago
Los Angeles, United States Tarzana Treatment Center Full timeJob DescriptionJob DescriptionPosition Title:Authorization Specialist IIDepartment: Quality Assurance Reports To: QA SupervisorPOSITION SUMMARYUnder the general supervision of the Quality Assurance Supervisor, the Authorization Specialist focuses on managing contract patient authorization status issues. This position is also responsible for reporting on...
-
Authorization Specialist
2 weeks ago
Los Angeles, California, United States Hanger Clinic Full timeJob Title: Authorization SpecialistAt Hanger Clinic, we are seeking a highly skilled Authorization Specialist to join our team. As a key member of our front office, you will play a critical role in ensuring seamless patient care and administrative support.Key Responsibilities:Coordinate and administer front office activities, providing exceptional support to...
-
Oncology Clinical Nurse Specialist
4 weeks ago
Los Angeles, California, United States Clinical Management Consultants Full timeAbout the RoleWe are seeking a highly skilled Oncology Clinical Nurse Specialist to join our team at Clinical Management Consultants. As a key member of our healthcare team, you will be responsible for providing expert clinical guidance and support to our Oncology unit.Key ResponsibilitiesDevelop and implement evidence-based clinical practices to improve...
-
Clinical Specialist-Medical Device Expert
23 hours ago
Los Angeles, California, United States Clinical Search Group, LLC Full timeUnlock Your Potential as a Clinical Specialist-Medical DeviceAre you a Registered Dietitian, Certified Diabetes Care and Education Specialist (CDCES), or nurse looking for a new challenge? Do you have a passion for delivering exceptional patient care and education? We have an exciting opportunity for a Clinical Specialist-Medical Device to join our team at...
-
Unblinded Clinical Pharmacist Specialist
4 weeks ago
Los Angeles, California, United States Matrix Clinical Research Full timeJob OverviewBenefits:401(k) planAttractive salary packageComprehensive health coverageOpportunities for training and professional growthMatrix Clinical Research is a premier organization focused on enhancing medical understanding through pioneering clinical studies. Our team consists of highly qualified professionals dedicated to elevating patient outcomes...
-
Eligibility and Authorization Specialist II
3 weeks ago
Los Angeles, California, United States Children's Hospital Los Angeles Full timeJob SummaryChildren's Hospital Los Angeles (CHLA) is seeking a highly skilled Eligibility and Authorization Specialist II to join our team. As a key member of our financial clearance team, you will be responsible for requesting and obtaining authorizations, organizing and updating worklists, and serving as a liaison between patients, CHLA, and third-party...
-
Clinical Trial Unblinded Operations Specialist
4 weeks ago
Los Angeles, California, United States Matrix Clinical Research Full timeJob DescriptionPosition OverviewWe are looking for a meticulous and skilled Clinical Trial Unblinded Operations Specialist to enhance our clinical research initiatives. This role is pivotal in safeguarding the integrity of our clinical studies by overseeing all unblinded functions. The candidate must exhibit unwavering compliance with protocols and...
-
Oncology Clinical Nurse Specialist
4 weeks ago
Los Angeles, CA, United States Clinical Management Consultants Full timeA fantastic hospital in the Los Angeles area is in search of a new Oncology Clinical Nurse Specialist. This hospital has earned numerous awards for units throughout their facility. In addition, this hospital is accredited in many areas, but notably has a glowing record in their Oncology Services. The facility has also earned the title of one of the Best...
-
Unblinded Clinical Trials Pharmacist
4 weeks ago
Los Angeles, California, United States Matrix Clinical Research Full timePosition OverviewMatrix Clinical Research is at the forefront of enhancing medical knowledge through pioneering clinical trials. Our dedicated team comprises highly qualified professionals focused on elevating patient care through meticulous research initiatives.Role Summary:We are in search of a knowledgeable and meticulous Unblinded Pharmacist to become an...
-
Clinical Research Specialist
4 weeks ago
Los Angeles, California, United States CEDARS-SINAI Full timePosition Overview:As a Clinical Research Specialist, you will play a vital role in overseeing laboratory operations, ensuring compliance with safety regulations, and managing research projects effectively. Key Responsibilities:Under the general supervision of the Principal Investigator, you will: Manage laboratory activities, including financial oversight...
-
Clinical Scheduling Specialist
4 weeks ago
Los Angeles, California, United States Alliance Home Health Group Full timeJob OverviewQualifications:Minimum of 1 year experience in home healthcare settings.Key Responsibilities:The Clinical Scheduling Specialist plays a crucial role in organizing and overseeing clinician schedules based on patient requirements, authorizations, and clinician availability.This position is essential for coordinating the schedules of our healthcare...
-
Clinical Trial Specialist
1 week ago
Los Angeles, California, United States Barrington James Full timePart-Time Clinical Trial Specialist OpportunityBarrington James is seeking a skilled Clinical Trial Specialist to support our client with clinical site agreement negotiations and general support with agreements.Key Responsibilities:Ensure effective negotiation and ongoing management of clinical trial agreements with investigative sites.Collaborate with...
-
Clinical Laboratory Specialist
4 weeks ago
Los Angeles, California, United States VETERANS HEALTH ADMINISTRATION Full timePosition OverviewThis role is situated within the Pathology and Laboratory Medicine Service. The Clinical Laboratory Specialist (Quality Management) delivers expert consultative management within a clinical laboratory environment. This position is responsible for upholding a Laboratory quality management program and ensuring the evaluation of components and...
-
Patient Authorization Representative
2 months ago
Los Angeles, United States UCLA Health Full timeAs a Patient Authorization Representative, you will be responsible for:Pre-encountering and pre-registering patients as well as providing registration support to patients, clinic staff, and managers. Verifying insurance and enter insurance benefits i Representative, Authorization, Patient, Retail, Healthcare, Insurance
-
Los Angeles, California, United States Molina Healthcare Full timeJob SummaryMolina Healthcare Services (HCS) is seeking a skilled Care Review Clinician, Prior Authorization to join our team. As a key member of our healthcare team, you will work closely with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum.Key...
-
Advanced Clinical Nurse Specialist
4 weeks ago
Los Angeles, California, United States University of California Full timePosition Overview: The Clinical Nurse Specialist (CNS) serves as the clinical nursing authority for Perianesthesia and Procedural programs at the University of California. This role demands advanced expertise and competencies that encompass clinical proficiency, evidence-based methodologies, collaboration, consultation, education, mentoring, and...
-
Clinical Specialist
2 months ago
Los Angeles, United States Accordance Search Group Full timeThe Field Clinical Specialist works using independent judgement, partners with local Account Managers to increase clinical support and education, resulting in clinical acumen. This role will entail educating physicians on device handling, implementation, and troubleshooting techniques. Also, develop and lead training sessions and in-services. Must be willing...
-
Los Angeles, California, United States Regal Medical Group, Inc. Full timeJob SummaryThe Nurse Reviewer - Quality and Cost Effectiveness Specialist will play a crucial role in promoting the quality and cost-effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization specialty referral requests as well as acute inpatient admission.Key...
-
Clinical Trial Specialist
2 weeks ago
los angeles, United States Barrington James Full time6 Months Contract - Part-Time - On-SiteBarrington James is looking for a Clinical Trial Specialist to assist our client with clinical site agreement, negotiations and general support with agreements.Responsibilities:Ensure effective negotiation and ongoing management of clinical trial agreements with investigative sites.Collaborate across Clinical Operations...
Clinical Authorization Specialist
3 months ago
The Clinical Authorization Specialist will take the lead in securing medical authorizations from third party payers (commercial and government) for outpatient clinic, inpatient admission, ancillary services and/or chemotherapy and other infused treatments as needed in assigned service line. The Specialist will be instrumental in obtaining written documentation, submitting tracking, reporting and documenting outcomes of each authorization request. The Specialist will be in a position to interface directly with medical/clinical staff and pharmacy to ensure a seamless process to the patients receiving treatment.
The Specialist - Clinical Authorization will take the lead in securing medical authorizations from third party payers (commercial and government) for outpatient clinic, chemotherapy treatments, and/or other requested services/ procedures, inpatient admission and ancillary services as needed. The Representative will be instrumental in obtaining written documentation, submitting, tracking reporting and documenting outcomes of each authorization request. The Specialist will be in a position to interface directly with medical and clinical staff and pharmacy to ensure a seamless process to the patients receiving outpatient clinic, inpatient admission ancillary services, chemotherapy treatments or other procedures as requested. This position will report to Administrative Clinic Manager and will assist in the operation of Koreatown/ Buena Park Medical Oncology/ Multi
- Disciplinary Clinic.
**Essential Duties**:
- Actively obtain written clinical documentation for ambulatory clinic consultation/examinations, OT/PT, procedural, treatment authorizations in Keckcare for authorization submission from Medical/Nursing Staff.
- Submit pre-certification/pre determination documentation to third party payers/payers insurance carrier for authorization with correct CPT and ICD coding
- Research payers medical policy requirements for ambulatory clinic consultation/ examinations, OT/PT, procedural, treatment authorizations and understand process for submitting pre-certification/pre
- determination requests
- Utilize Excel tracking log to document authorization requests, follow-up on items and provide outcomes to the Supervisor daily, prior to end of shift.
- Follow-up on outstanding authorization requests and on medical documentation requests in a timely manner.
- Enroll patients in manufacturer patient assistance programs as needed and follow-up regarding enrollment and/or medication reimbursements
- Communicate with a medical/clinical/pharmacy staff and patients on authorization status/outcome.
- Coordinate with Director on denied or disputed claims to obtain documentation to support ambulatory clinic consultation/ examinations, OT/PT, procedural, treatment
- Exhibit sensitivity to the patients at all times concerning privacy and confidentiality while accessing medical records for ambulatory clinic consultation/ examinations, OT/PT, procedural, treatments to process authorizations requests
- Scan all authorizations into Keck care under the respective patient accounts and if applicable, forward authorized orders to pharmacy for dispensing
- Maintain medical policy coverage binder and keep updated with new policies and forms regarding medications FDA indicated usage and authorization requirements.
- Document authorization outcome in all financial systems.
- Performs other duties as assigned.
**Required Qualifications**:
- High school or equivalent Or equivalent evidence in file.
- 2 years Experience in a hospital, medical office/doctor’s office or working for a health insurer.
- Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills
- Able to function independently and as a member of a team.
- Demonstrate excellent customer service behavior.
**Preferred Qualifications**:
- Experience in area of service.
- Medical Prior Authorizations or Claims experience in a managed care setting.
- Orthalmic experience
- Knowledge of medical terminology.
- Knowledge of the health insurance industry and claims processing.
**Required Licenses/Certifications**:
- Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)