Top 168 Prior authorization Jobs in Laguna Hills, Ca

Transfer Center Representative : Transfer Center
Hoag Health System —Newport Beach, CA
- Full-time
- Surgery
- Computer literacy
- HIPAA
12d
Insurance Verification Coordinator l
AmeriPharma —Laguna Hills, CA
- $25 - $30 an hour
- 8 hour shift
- Microsoft Excel
- Microsoft Outlook
- Medical office experience
- Health insurance
- Dental insurance
Quick Apply
13d
Authorization Specialist
Oso Home Care —Irvine, CA
- $21.00 - $25.90 an hour
- Full-time
- Background check
- Computer literacy
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Financial Counselor - OC Hospital
City of Hope —Irvine, CA
- $28.16 - $39.43 an hour
- Full-time
- Hospital
- Mid-level
- 3 years
Patient Coordinator (Part-Time)
Orthopaedic Specialty Institute Medical Group of Orange County —Laguna Hills, CA
- $25 an hour
- 8 hour shift
- Surgery
- Computer literacy
- High school diploma or GED
Quick Apply
Clinical Technician (TMS)
Salma Health —Laguna Hills, CA
- $24 - $25 an hour
- Full-time
- LVN
- Patient monitoring
- Mid-level
- Health insurance
- Dental insurance
Authorization Coordinator
RETINA ASSOCIATES OF ORANGE COUNTY —Laguna Hills, CA
- 8 hour shift
- Spanish
- Surgery
- Writing skills
- Health insurance
- Dental insurance
Quick Apply
Reimbursement Specialist, Appeals
Lucid Diagnostics —Lake Forest, CA
- Full-time
- HIPAA
- Mid-level
- Bachelor's degree
- Employee stock purchase plan
- Paid holidays
Quick Apply
Intake Representative (IVIG)
RE Pharmacy —Irvine, CA
- $28 - $32 an hour
- Weekends as needed
- Customer service
- 5 years
- Mid-level
- Health insurance
Quick Apply
Specialty Billing Technician
Walgreens —Mission Viejo, CA
- $22 - $29 an hour
- Full-time
- Writing skills
- Mid-level
- High school diploma or GED
9d
UM Coordinator
Astiva Health —Orange, CA
- $27 - $31 an hour
- Full-time
- Background check
- LVN
- Word processing
- Health insurance
- Dental insurance
Quick Apply
Patient Access Representative III - OC Per Diem
City of Hope —Irvine, CA
- $25.78 - $36.09 an hour
- Per diem
- Clinic experience
- Mid-level
- High school diploma or GED
Biller IV - HB Patient Financial Services - FT Days
University of California, Irvine —Anaheim, CA
- $32.81 - $40.80 an hour
- Full-time
- Background check
- Mid-level
- Math
- Health insurance
- Retirement plan
Patient Care Coordinator
WESTERN GROWERS GROUP —Irvine, CA
- $40,580.28 - $52,756.02 a year
- Full-time
- Remote
- Spanish
- HIPAA
- English
Quick Apply
13d
Administrative Assistant
Northern Trust Corp. —Newport Beach, CA
- $55,200 - $82,800 a year
- Full-time
- Computer literacy
- No experience needed
- Office
- Health insurance
- Dental insurance
Pharmacy Intake Coordinator
BMR Partners —Orange, CA
- $24 - $30 an hour
- Full-time
- English
- Mid-level
- High school diploma or GED
- Health insurance
- Dental insurance
Quick Apply
Front Desk Receptionist
OC Sports and Rehab —Mission Viejo, CA
- $20 - $21 an hour
- 8 hour shift
- Data entry
- In-person
- Entry level
- Health insurance
- Dental insurance
Quick Apply
Pharmacy Technician II-Per Diem
City of Hope —Irvine, CA
- $33.48 an hour
- Per diem
- Hospital
- Mid-level
- High school diploma or GED
13d
Medical Collector - PB Financial Services - FT Days
University of California, Irvine —Anaheim, CA
- $26.58 - $37.75 an hour
- Full-time
- Background check
- Customer service
- English
- Health insurance
- Retirement plan
Ambulatory Care Assistant: Digestive Health Clinic
Hoag Health System —Aliso Viejo, CA
- Full-time
- Bilingual
- Vital signs
- Microsoft Outlook

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Transfer Center Representative : Transfer Center

Hoag Health System -
Newport Beach, CA

Apply Now

Job Details

Full-time
12 days ago

Qualifications

Employee relationship building
High school diploma or GED
Office experience

Full Job Description

Reporting to the Patient Access Supervisor, the Transfer Center Representative supports hospital-wide patient flow, access, and operational coordination while maintaining compliance with Federal, State, and local regulations. This role collaborates extensively with Nursing Leadership, EVS, Central Dispatch, Staffing Office, Security, Case Management, Surgical Services, and other key departments to ensure seamless patient placement, accurate registration, insurance verification, and timely transfer coordination.

The Transfer Center Representative serves as the centralized communication hub for patient movement across campuses and is responsible for facilitating daily operational meetings, managing bed placement, coordinating interfacility transfers, processing work queues, and ensuring accurate and complete patient accounts. The ideal candidate thrives in a fast-paced, high-acuity environment, demonstrates exceptional customer service, maintains advanced computer proficiency, and consistently supports efficient and safe patient throughput.

Job Specific Essential Functions

Patient Access, Registration & Billing

Facilitates the arrival process by creating accounts for initial intake and monitoring queues to ensure timely registration.
Follows HIPAA protocols and ensures accurate and complete patient registration.
Verifies insurance eligibility, codes insurance accurately, and supports timely reimbursement.
Provides patients with insurance and billing assistance and identifies coverage concerns immediately.
Confirms and communicates registration status, including in-network/out-of-network coverage, and prevents delays in patient care.
Performs quality audits on accounts and provides staff reeducation based on findings.
Updates patient accounts to ensure proper billing, documentation, and financial accuracy.
Meets and exceeds daily productivity expectations.
Obtains authorizations for out-of-network (OON) admissions.
Calls and faxes face sheets and clinical documentation to out-of-network case management teams to secure timely authorization.
Adds COVID billing indicators for patients testing positive.
Adds and removes No Information billing indicator flags to ensure privacy compliance and accurate account status.

Bed Placement, Hospital Flow & Operational Coordination

Coordinates room and bed placement for all admission types, including ED, direct admissions, transfers, lateral moves, surgical/procedural patients, booked admissions, and Benefactor Program patients.
Holds beds the night prior for scheduled admits to ensure seamless direct admissions and smooth throughput.
Verifies every admission has correct and complete physician orders prior to assignment.
Tracks surgical admissions, including expected admit times and anticipated times out, to support proactive planning and capacity management.
Collaborates with charge nurses across all departments to ensure placement aligns with the patient’s diagnosis, acuity, isolation requirements, and safety needs.
Works with surgical and procedural charge nurses to prioritize postoperative and pre-operative bed readiness based on OR schedule, clinical need, and downstream throughput.
Coordinates with ED charge nurses to review acuity, prioritize patient placement, and support emergency department flow.
Partners with EVS to expedite room turnover and uses Transfer Center–exclusive access to flag rooms as STAT, dirty, or next-room-clean to optimize bed availability.
Reviews potential patient holds with Staffing Coordinators and evaluates nursing resource allocation to support balanced staffing across campuses.
Works with Central Dispatch to prioritize patient transports for admissions, transfers, and discharges, ensuring timely and safe movement throughout the hospital.
Provides real-time hospital census and capacity updates to house supervisors, nursing leadership, and the staffing office to support operational decisions.

Transfer Coordination (Internal & External)

Coordinates transfers between Hoag Hospital and Hoag Orthopedic Institute (HOI), ensuring seamless communication between the sending and receiving teams.
Facilitates incoming and outgoing transfers based on clinical need, physician requests, levels of care, patient/family requests, or continuity of care considerations.
Arranges peer-to-peer discussions between hospitals for incoming transfer requests to support efficient decision-making and timely acceptance.
Works closely with Case Management to confirm acceptance, review medical necessity, and ensure all requirements are met for safe patient transfer.
Obtains Transfer-Back Agreements to ensure regulatory compliance and protect patient return rights.
Requests and tracks Letters of Agreement (LOAs) for out-of-network or single-case agreements to ensure patient financial coverage and prevent delays in care.

Daily Operations, Reporting, & Meeting Facilitation

Facilitates the daily interdisciplinary operations huddle, serving as the central point of coordination for communication between clinical teams, leadership, support services, and ancillary departments.
Leads discussions related to patient placement priorities, unit pressures, staffing considerations, escalation items, and operational barriers.
Keeps detailed meeting minutes and ensures documentation is uploaded to Teams and SharePoint for access by leadership and upper management.
Runs and analyzes operational reports related to throughput, capacity, transfers, patient status changes, and outstanding tasks.
Manages daily work queues (WQs) related to registration, insurance, transfers, and financial clearance.
Reviews surgical case admission orders to ensure accuracy and prevent delays.

Quality, Training & Problem Solving

Conducts regular quality audits on patient accounts, identifying errors, discrepancies, or missing information.
Provides staff reeducation and process clarification based on audit findings.
Serves as a resource and mentor to new team members, supporting onboarding and ongoing peer training.
Demonstrates independent decision-making during routine operations and emergency situations.
Supports leadership with special projects designed to improve throughput, patient experience, and operational efficiency.

Additional Responsibilities

Maintains knowledge of all patient access roles relevant to supported areas.
Provides admissions coverage as needed.
May require local travel between campuses.
Performs other duties as assigned.

Education & Experience

High school diploma or equivalent required.
Minimum of one (1) year of general office or customer service experience.
Proficient keyboarding and accurate data entry skills.
Strong verbal and written communication skills.
Advanced analytical, critical thinking, and decision-making abilities.
Ability to multitask in a fast-paced environment.
Ability to build positive working relationships.

Licenses Required:

N/A

Licenses Preferred:

N/A

Certifications Required:

N/A

Certifications Preferred:

N/A

Apply Now

Refine Your Search

prior authorization jobs in laguna hills, ca

Transfer Center Representative : Transfer Center

Insurance Verification Coordinator l

Authorization Specialist

Financial Counselor - OC Hospital

Patient Coordinator (Part-Time)

Clinical Technician (TMS)

Authorization Coordinator

Reimbursement Specialist, Appeals

Intake Representative (IVIG)

Specialty Billing Technician

UM Coordinator

Patient Access Representative III - OC Per Diem

Biller IV - HB Patient Financial Services - FT Days

Patient Care Coordinator

Administrative Assistant

Pharmacy Intake Coordinator

Front Desk Receptionist

Pharmacy Technician II-Per Diem

Medical Collector - PB Financial Services - FT Days

Ambulatory Care Assistant: Digestive Health Clinic

I want to receive the latest job alert for prior authorization in laguna hills, ca

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