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, and treatment facilities in 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. 

Position Summary:
The Research Insurance Specialist essential in the success of supporting clinical trials, the primary task is to verify insurance policy benefit information and obtain authorizations/pre-certifications for services not covered by the clinical trial study. The Research Insurance Specialist will verify with the clinical trial patient’s insurance provider if the incumbent has coverage to participate in the proposed trial, if approved then using a clinical trial study coverage analysis, the research insurance specials will determine for each upcoming appointment whether or not the upcoming service will be covered by the study sponsor or whether the service needs prior authorization to be covered by the patient’s insurance. The Research Insurance Specialist is responsible for obtaining timely authorizations/pre-certifications when needed for all services not covered under the study.

As a successful candidate, you will: 

Obtain Insurance Benefits Confirmation: 
•    Review billing grid/budget and compile list of all standard of care procedures associated to research
•    Verifies hospital and professional insurance policy benefits for clinical trial patients. The verification process includes: Telephone contact, Mail/Facsimile, On-line inquiry
•    Enters information concerning the policy benefits into the system and updates insurance information in the system

Ongoing Authorization:
•    Review billing grid/budget to determine if upcoming services require authorization and update in medical record.
•    Request authorization extension or new authorizations for continuity of care for research as needed or when coverage changes and inputs updates into the system.
•    Receives and reads City of Hope managed care contracts summaries to obtain an understanding of the contract provisions and interprets for insurance coverage.  Acts as resource regarding managed care contract changes and updates.

Your qualifications should include: 

• High School Diploma
• 2 years of related experience and 1+ years of healthcare experience 
   

City of Hope employees pay is based on the following criteria: work experience, qualifications, and work location.

City of Hope is an equal opportunity employer.

To learn more about our Comprehensive Benefits, please CLICK HERE.