Senior Insurance Specialist – Clinical Trials

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City of Hope

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🧬 Biotechnology

🔬 Science

💰 $5.4M Grant - City of Hope on 2024-05

Healthcare • Biotechnology • Science

City of Hope is a nonprofit, NCI-designated comprehensive cancer center and research hospital near Los Angeles that provides patient care, conducts translational biomedical research, and offers education and clinical trials across a national network. It focuses on cancer, diabetes, and other life‑threatening diseases, combining clinical services, laboratory science, training and community outreach to develop new treatments and support patients and families.

📋 Description

• Help oversee daily activities of the Research Insurance Specialist team, including assignments, scheduling coverage, onboarding, training, quality monitoring, coaching, and productivity tracking. • Serve as a team resource and liaison when Research Patient Access leadership is unavailable, and participate in workgroups, committees, special projects, and team meetings. • Review clinical trial billing grids and budgets to identify standard-of-care procedures and determine whether upcoming services require insurance authorization. • Verify hospital and professional insurance benefits for clinical trial patients through telephone, mail, fax, and online inquiries. • Enter and maintain accurate policy benefit, coverage, and authorization information in applicable systems and the medical record. • Coordinate with research nurses, case managers, financial counselors, referral teams, registration, clinics, providers, and insurance carriers to obtain timely authorizations and pre-certifications. • Request authorization extensions or new authorizations to support continuity of care when services or coverage change. • Interpret managed care contract summaries, respond to coverage questions, support denial reviews and appeals, and help resolve outstanding account issues. • Deliver exceptional service to patients, providers, colleagues, and leaders while managing multiple priorities and taking prompt action on high-priority situations. • Maintain productivity, accuracy, confidentiality, and compliance with departmental and City of Hope policies, procedures, and standards.

🎯 Requirements

• Associate degree, or equivalent experience in place of the minimum education requirement. • Five years of related experience, including at least three years of healthcare experience. • Strong customer service, communication, organization, problem-solving, and workload-management skills. • Ability to work independently with limited supervision and collaboratively within a team environment. • Proven ability to manage competing priorities, work toward measured goals, delegate workload, and remain professional under pressure. • Detail-oriented, flexible, persuasive, accountable, and committed to integrity. • Proficiency in Microsoft software and a range of PC applications. • Bachelor’s degree preferred. • Healthcare insurance authorization experience preferred. • Maintain confidentiality and comply with departmental and City of Hope policies, procedures, and standards.

🏖️ Benefits

• Comprehensive Benefits • Remote work arrangement