Job Description
Overview:
Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Healthcare Authorization Specialist.
*** Candidate must be authorized to work in USA without requiring sponsorship ***
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*** Location: Emeryville, CA 94608
*** Duration: 13-week contract with the possibility of extension
Notes:
- Pay Rate: $50.88/hr on W2.
- Work Schedule: Mon – Fri, 8:00am – 4:30pm Pacific Time (40 hours per week work).
- Hybrid role: 16 - 32 hours a month onsite.
Description:
- The California Children’s Services (CCS) Authorization Representative is individually accountable for securing treatment authorizations for the CCS patient population that includes inpatient admissions and ancillary outpatient services.
- The CCS Unit is responsible for meeting organizational financial targets of approximately $22 million each week for CCS DNB (Discharged Not Billed) patient accounts.
- Collectively, the CCS Authorization Representative team contributes to timely and appropriate patient access and service for CCS covered conditions.
- The scope of work that the Authorization Representative is responsible for requires ongoing account analysis, consistent communication of technical medical language and unique patient accounts and CCS coverage guidelines and billing knowledge.
- The primary responsibility of the CCS Authorization Representative is to communicate patient services authorization requests with all CCS service area counties, for the approximate 58 counties throughout the State of California, and requesting authorizations by submitting Service Authorization Request (SAR) forms.
- The CCS Authorization Representative works closely with case managers and ordering providers’ office staff and external clinical professionals.
- On occasion and in conjunction with the unit supervisor, may interact with State Medical Directors to resolve individual account authorization or coverage issues.
- In general, the CCS Authorization Representative is responsible for all aspects of financially securing CCS insurance and authorization data for patient services.
- The CCS Authorization Representative’s responsibilities include, though are not limited to 1) verifying demographic and clinical information relevant to the patient’s visit 2) verifying insurance eligibility and benefits, 3) securing authorizations, and 4) properly notating all activity in APeX EHR system.
Qualifications:
- Three years of clerical experience, including two (2) years at the Admitting Worker or comparable level.
- Proficiency in health insurance eligibility, authorization requirements, and coordination of benefits.
- Knowledge of government program regulations, Medi-Cal, CCS, and third-party payor patient liability determination.
- Strong knowledge of Medi-Cal, CCS guidelines, and complex multi-payer coordination of benefits scenarios.
- Must have recent, hands-on CCS authorization experience as a core function of their role.
- Strong preference for candidates who regularly submit SARs and work directly with California Children’s Services across multiple counties.
- High-volume authorization workload experience, including end-to-end account management, follow-ups, denials, and escalations.
- Ability to solve problems, analyze accounts/data, and recommend or implement changes.
- Ability to work independently with minimal supervision and resolve authorization or coverage issues efficiently.
- Demonstrated ability to utilize, understand, and adapt to electronic health record systems, billing systems, and workflow management tools.
- EPIC or APeX experience required, including documentation and workflow management within the system.
- ADT experience required; knowledge of office machines, typing 30 wpm, and basic PC skills required.
- Strong attention to detail with understanding of cause-and-effect impacts when accounts are not processed appropriately.
- Excellent customer service skills with the ability to interact effectively with medical providers, clinic and department staff, CCS county offices, and diverse patient/family populations.
- Ability to work collaboratively with culturally diverse staff and patient/family populations.
- Articulate and concise oral communication skills.
- Ability to write clearly and concisely in English.
- Seeking a highly experienced Authorization Specialist with a background in authorization, financial clearance, or utilization review rather than general patient access, admitting, registration, or front desk functions.
- Ideal candidates will have 5+ years of specialized authorization experience.
- Resumes should clearly demonstrate CCS and authorization responsibilities as primary job functions.
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I'd love to talk to you if you think this position is right up your alley, and assure a prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you.
Satwinder “Sat” Singh
Lead Technical Recruiter
Company Overview:
Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally, as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients’ businesses forward.
Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws.