Top 9342 Jobs in Fresno, CA

Medical Insurance Authorization Specialist
Madera Community Hospital —Madera, CA
- $27 - $32 an hour
- Full-time
- Nursing
- LVN
- RN License
- Health insurance
- Dental insurance
Quick Apply
Certified Electrician
TENCO SOLAR —Fresno, CA
- $80,000 - $120,000 a year
- Full-time
- Clean driving record
- Construction site
- Customer service
- Health savings account
- Paid holidays
Quick Apply
Preschool Associate Teacher
Educare Services, Inc. —Selma, CA
- From $24 an hour
- Part-time
- Background check
- Classroom
- Preschool
- 401(k)
- Retirement plan
Quick Apply
Pest Control Technician
Fast Action Pest Control —Fresno, CA
- $21 - $28 an hour
- Full-time
- Clean driving record
- Residential
- High school diploma or GED
- Paid training
- Fuel card
Quick Apply
Shop Foreman/ Lead Mechanic
Standard Truck and Trailer Sales —Fresno, CA
- $65,000 - $80,000 a year
- Overtime
- Background check
- Spanish
- Mechanic experience
- Health insurance
- 401(k)
Quick Apply
Payroll Specialist
BBSI —Fresno, CA
- $27 - $32 an hour
- Full-time
- Background check
- Microsoft Outlook
- Up to 50% travel
- Commuter assistance
- Health savings account
Quick Apply
Swimming Pool Service Technician
Gary's Pool Care —Clovis, CA
- $18 - $20 an hour
- Part-time
- Background check
- Clean driving record
- Residential
- Dental insurance
- Paid time off
Quick Apply
Tow Truck Driver/Operator
West Coast Towing —Fresno, CA
- $660 - $1,500 a week
- Part-time
- Clean driving record
- Driver's License
- Conflict management
- Paid training
Quick Apply
Project Coordinator
Architectural Wood Design —Fresno, CA
- $22 - $27 an hour
- Full-time
- ERP systems
- Mid-level
- Office
Quick Apply
Medical Scribe
Internal Medicine Practice —Fresno, CA
- $18 - $22 an hour
- Part-time
- Anatomy knowledge
- Medical office experience
- English
Quick Apply
5d
Solar / Battery Technician
KS Electric —Fresno, CA
- $30 - $35 an hour
- Full-time
- Mid-level
- Residential
- 3 years
- Health insurance
- 401(k)
Quick Apply
2d
Service Detailer
Local dealership —Clovis, CA
- From $17 an hour
- Full-time
- Clean driving record
- Dealership
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Fire Sprinkler Fitter
Jorgensen Company —Fresno, CA
- $30 - $40 an hour
- Full-time
- Background check
- Pass drug screening
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Transportation Supervisor
Welbehealth —Fresno, CA
- $75,000 - $80,000 a year
- Full-time
- Background check
- Management
- Inventory control
- Health insurance
- Dental insurance
Quick Apply
Direct Support Professional / DSP / Caregiver
AbleLight —Fresno, CA
- $16.50 - $18.50 an hour
- Residential
- High school diploma or GED
- Communication skills
Quick Apply
3d
Production Supervisor
PB Loader Corporation —Fresno, CA
- $28 - $33 an hour
- Overtime
- Mid-level
- Assembly
- Driver's License
- Health insurance
- Dental insurance
Quick Apply
3d
ABA Scheduler - California Based
MeBe —Fresno, CA
- $24 - $29 an hour
- Full-time
- Remote
- Google Workspace
- Mid-level
- Analysis skills
- Continuing education credits
- AD&D insurance
Quick Apply
6d
Human Resource Associate
Valley Health Team, Inc. —Fresno, CA
- $21.86 - $28.52 an hour
- Full-time
- Background check
- Spanish
- Microsoft Excel
- Health savings account
- Health insurance
Quick Apply
General Production Loader
Westair Gases and Equipment, Inc. —Fresno, CA
- $20 - $22 an hour
- Overtime
- Microsoft Outlook
- Customer service
- Computer literacy
- Health savings account
- Paid holidays
Quick Apply
10d
Solar Sales Representative - Training Bonus
Sunrun —Fresno, CA
- $60,000 - $90,000 a year
- Weekends as needed
- 18 years or older
- Residential
- Outdoor work
- Paid training
- Opportunities for advancement
Quick Apply

I want to receive the latest job alert for jobs in Fresno, CA

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Medical Insurance Authorization Specialist

Madera Community Hospital
Madera, CA

Quick Apply

Job Details

Full-time
$27 - $32 an hour

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance

Qualifications

Writing skills
CMS
HIPAA
High school diploma or GED
CMS regulatory compliance
Medicare regulations
Document review
Computer skills
Medical Billing & Coding
Associate's degree
Medical terminology
Documentation review
Documentation reviews

Full Job Description

Position Summary

The Insurance Authorization Denial Specialist is responsible for reviewing, analyzing, and resolving authorization-related denials for inpatient admissions, with a primary focus on patients admitted through the Emergency Department. This position works closely with Case Management, Utilization Review, ED physicians, hospitalists, and insurance payers to overturn denials by demonstrating that admissions met inpatient clinical criteria under InterQual or MCG guidelines at the time of the admission decision.

The ideal candidate has a strong working knowledge of utilization review, payer medical necessity standards, ED-to-inpatient admission workflows, and the clinical documentation required to support an inpatient level of care.

Essential Duties and Responsibilities

Review and resolve authorization denials, medical necessity denials, level-of-care downgrades (inpatient to observation), and concurrent review denials issued by commercial, managed care, Medicare Advantage, and Medi-Cal Managed Care payers.
Analyze ED documentation, H&P, physician orders, and clinical course to determine whether the admission met InterQual or MCG inpatient criteria at the point of admission.
Prepare and submit timely peer-to-peer requests, reconsiderations, and written clinical appeals citing the specific InterQual or MCG criteria met, supported by source documentation from the medical record.
Coordinate peer-to-peer reviews between hospitalists, ED physicians, and payer medical directors; track outcomes and follow up on verbal authorizations in writing.
Partner with Case Management and Utilization Review to identify documentation gaps that contributed to a denial and communicate findings back to ED and hospitalist providers.
Monitor payer portals, fax queues, and correspondence for adverse determinations, NOMNC notices, and authorization status updates; ensure denials are worked within payer appeal timeframes.
Track denial reasons, payers, admitting providers, and criteria sets involved; identify recurring patterns (e.g., observation downgrades, missed notification windows, criteria not clearly documented) and report trends to leadership.
Ensure compliance with payer contract terms, CMS Two-Midnight Rule, Condition Code 44 procedures, and Medi-Cal authorization requirements.
Maintain accurate documentation of all denial activity, appeal submissions, and outcomes within the hospital's UR and patient accounting systems.
Support payer audits and respond to requests for additional clinical information.
Participate in process improvement initiatives aimed at reducing avoidable denials at the front end — including notification of admission, concurrent review timeliness, and physician documentation of inpatient criteria.
Maintain confidentiality of patient information in accordance with HIPAA.
Perform other duties as assigned.

Minimum QualificationsEducation

High school diploma or equivalent required.
Associate or Bachelor's degree in Nursing, Health Information Management, Healthcare Administration, or related field preferred.

Experience

Minimum of two (2) years of utilization review, case management, denials management, or payer authorization experience preferred.
Hospital acute care experience strongly preferred, particularly with ED admissions and observation-versus-inpatient determinations.

Knowledge, Skills, and Abilities

Working knowledge of InterQual and/or MCG inpatient admission criteria and how to apply them to ED presentations.
Understanding of payer medical necessity standards, concurrent review, peer-to-peer processes, and the appeal hierarchy across commercial, Medicare Advantage, and Medi-Cal Managed Care lines.
Familiarity with the CMS Two-Midnight Rule, Condition Code 44, observation status rules, and NOMNC requirements.
Strong clinical documentation review skills and the ability to translate physician documentation into criteria-based justification.
Excellent written communication skills, including the ability to draft persuasive clinical appeal letters.
Ability to prioritize a denial queue against payer appeal deadlines.
Proficient with EMR systems, payer portals, and UR review platforms.

Preferred Qualifications

Active LVN or RN license, or InterQual / MCG certification.
Prior experience writing clinical appeals or representing the hospital in peer-to-peer reviews.
Experience with Meditech EHR.
Familiarity with managed Medi-Cal plans serving the Central Valley (e.g., CalViva, Anthem Blue Cross, Health Net).

Pay: $27.00 - $32.00 per hour

Benefits:

401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance

Work Location: In person

Quick Apply

Refine Your Search

jobs in Fresno, CA

Medical Insurance Authorization Specialist

Certified Electrician

Preschool Associate Teacher

Pest Control Technician

Shop Foreman/ Lead Mechanic

Payroll Specialist

Swimming Pool Service Technician

Tow Truck Driver/Operator

Project Coordinator

Medical Scribe

Solar / Battery Technician

Service Detailer

Fire Sprinkler Fitter

Transportation Supervisor

Direct Support Professional / DSP / Caregiver

Production Supervisor

ABA Scheduler - California Based

Human Resource Associate

General Production Loader

Solar Sales Representative - Training Bonus

I want to receive the latest job alert for jobs in Fresno, CA

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected