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Peds CaliforChildrens Svs Support - Admitting Worker
Ref No.: 18-07576
Location: Emeryville, California
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 electronic health record system.