Position Summary The Senior Research Insurance Specialist plays a key role in helping clinical trial patients navigate insurance coverage and authorization requirements. In this lead-level position, you will serve as a go-to resource for the Research Insurance Specialist team, guide daily work, and help ensure timely benefit verification, authorizations, and pre-certifications for services not covered by a clinical trial sponsor. You will use clinical trial coverage analyses, billing grids, and insurance information to determine coverage needs for upcoming services while partnering across research, clinical, financial, and access teams to support an efficient and compassionate patient experience.
As a successful candidate, you will: - 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.
Your qualifications should include: - 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.
City of Hope employees' pay is based on the following criteria: work experience, qualifications, and work location.
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