Top 48 Prior authorization specialist Jobs in Brea, Ca

UM Coordinator, Pre-Service (Remote | Pacific Time Schedule)
Alignment Healthcare USA, LLC —Orange, CA
- $41,472 - $62,208 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
Quick Apply
4d
Prior Authorization Specialist
Infusion4Health Inc —Brea, CA
- $22 - $27 an hour
- Full-time
- Microsoft Word
- Mid-level
- Office
Quick Apply
Intake Specialist
SpecialtyCare Rx —Diamond Bar, CA
- $30 - $35 an hour
- Full-time
- Management
- Mid-level
- Office
Quick Apply
Intake Coordinator - Full-Time
Oso Home Care —Irvine, CA
- $26 - $33 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Medical office experience
Quick Apply
Admissions Specialist
Royal Terrace Healthcare —Duarte, CA
- $25 - $30 an hour
- Full-time
- High school diploma or GED
- Entry level
- Health insurance
- Dental insurance
Quick Apply
3d
Clinical Authorization Specialist (Hospital) - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
USC —Los Angeles, CA
- $25.00 - $39.69 an hour
- 8 hour shift
- Nursing
- LVN
- Hospital
Clinical Authorization Specialist (Hospital) - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
Keck Medical Center of USC —Los Angeles, CA
- $25.00 - $39.69 an hour
- 8 hour shift
- Background check
- Nursing
- LVN
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
Customer Solutions Specialist - Las Vegas, NV
AbbVie —Pasadena, CA
- $84,500 - $162,000 a year
- Full-time
- Remote
- Computer literacy
- Mid-level
- Windows
- Paid holidays
- Health insurance
13d
Workers’ Compensation Administrative Coordinator
Southern California University —Whittier, CA
- $25 - $27 an hour
- Full-time
- Microsoft Outlook
- Computer literacy
- Mid-level
Quick Apply
Health Information Specialist
Pacific Neuropsychiatric Specialists Inc —Irvine, CA
- $23 - $24 an hour
- Full-time
- Medical office experience
- Mid-level
- Computer skills
- Health insurance
- Dental insurance
Quick Apply
2d
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 Clearance Specialist III - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)
USC —Los Angeles, CA
- $25.00 - $39.69 an hour
- 8 hour shift
- Medical office experience
- HIPAA
- Research
Patient Access Representative III - Duarte
City of Hope —Duarte, CA
- $25.78 - $36.09 an hour
- Full-time
- Hospital
- Medical office experience
- Mid-level
6d
Biller IV - HB Patient Financial Services - FT Days
University of California, Irvine —Anaheim, CA
- $30.94 - $38.48 an hour
- Full-time
- Background check
- Mid-level
- Math
- Health insurance
- Retirement plan
Financial Clearance Specialist IV - Admitting - Full Time 8 Hour Variable Shift (Non Union)
USC —Los Angeles, CA
- $26 - $34 an hour
- 8 hour shift
- Background check
- Medical office experience
- HIPAA
Pharmacy Prior Authorization Specialist
Infusion4Health Inc —Riverside, CA
- $22 - $30 an hour
- Full-time
- Microsoft Word
- Microsoft Outlook
- Mid-level
Quick Apply
Advanced Therapies Benefits Specialist (Financial Clearance)
Shields Advanced Therapies —Los Angeles, CA
- $65,000 - $85,000 a year
- Full-time
- Hybrid work
- 5 years
- Mid-level
- Office
Quick Apply
Member Services Representative
Astiva Health —Orange, CA
- $24 - $29 an hour
- Full-time
- Background check
- Spanish
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Claims Specialist
National Healthcare and Housing Advisors, LLC —Santa Ana, CA
- $26 an hour
- Full-time
- HIPAA
- Research
- Mid-level
- Health insurance
- Dental insurance
Quick Apply

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UM Coordinator, Pre-Service (Remote | Pacific Time Schedule)

Alignment Healthcare USA, LLC -
Orange, CA

Quick Apply

Job Details

Full-time
$41,472 - $62,208 a year
4 days ago

Qualifications

Microsoft Excel
Microsoft Outlook
Medicare
Medicare coding guidelines
Computer literacy
CMS
CMS regulatory compliance
Medicare regulations
Utilization management
Resource utilization in healthcare
Centers for Medicare & Medicaid Services (CMS) billing regulations
Typing
Medical terminology
File organization

Full Job Description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Alignment Health is seeking an organized, detail-oriented and customer service oriented utilization management (UM) Coordinator to join the utilization management pre-service team. As a UM coordinator, you get to assist and support the clinical team, UM nurse, and medical director with administrative task related to processing UM's clinical referrals.

If you are hungry to learn and grow, want to be part of a growing organization, and make a positive impact in the lives of seniors – we’re looking for you!

Schedule: (Required)
- Monday - Friday
- 8am - 5pm Pacific Time

GENERAL DUTIES / RESPONSIBILITIES:

Monitor fax folders.
Verify eligibility and / or benefit coverage for requested services.
Enter pre-service requests/authorizations in system using ICD 10 and CPT coding.
Verify all necessary documentation has been submitted for pre-service request.
Contact and request medical records, orders, and/or necessary documentation from requesting provider in order to process related pre-service requests/authorizations when necessary.
Document the referral process and any pertinent determination factors within the referral system.
Process pre-service request for medical services such as DME, office visits and radiology using approval criteria.
Assist with mailing or faxing correspondence to PCP’s, Specialists, related to requests / authorizations as needed.
Contact members and maintain documentation of call for Expedited requests.
Complete tasks assigned by nurse and document accordingly.
Answer queue calls relating to UM review and pre-service status.
Recognize work-related problems and contributes to solutions.
Meet specific deadlines and respond to various workloads by assigning task priorities according to department policies, standards and needs.
Maintain confidentiality of information between and among health care professionals.
Be a positive team player.

Job Requirements:

Experience:

Required:

Minimum (1) year experience in a medical setting working with IPAs, entering referrals / prior authorizations preferred.
Knowledge of ICD10, CPT codes, Medicare Managed Care Plans, medical terminology (certificate preferred) and referral system (Access Express/Portal/N-coder).
High school diploma or general education degree (GED) and / or training: or equivalent combination of education and experience required.
Computer proficient
Able to type minimum 50 words per minute (WPM)
Experience with Microsoft Office (Word, Excel, Outlook)
Experience with the application of UM criteria (i.e., CMS National and Local Coverage Determinations, etc.)
Bilingual English / Spanish preferred

Preferred:

Medical assistant experience preferred
Knowledge working in Access Express / Portal, Epic preferred.

Education:

Required:

High school diploma or general education degree (GED) or (4) years' additional experience in lieu of education.

Preferred:

Medical Terminology Certificate preferred.

Training:

Required:

Preferred:

Specialized Skills:

Required:

Proficient in Microsoft Office (Outlook, Excel, Word)
Able to type minimum 35 words-per-minute (WPM).
Organized and detail oriented.
File systematically.
Good interpersonal skills.
Strong written, verbal, and telephonic communication skills
Able to read, write, and speak English fluently.

Licensure:

Required: None

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear.

2. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

3. The employee frequently lifts and / or moves up to 10 pounds.

4. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $41,472.00 - $62,208.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].

Quick Apply

Refine Your Search

prior authorization specialist jobs in brea, ca

UM Coordinator, Pre-Service (Remote | Pacific Time Schedule)

Prior Authorization Specialist

Intake Specialist

Intake Coordinator - Full-Time

Admissions Specialist

Clinical Authorization Specialist (Hospital) - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Clinical Authorization Specialist (Hospital) - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Patient Access Representative III - OC Per Diem

Customer Solutions Specialist - Las Vegas, NV

Workers’ Compensation Administrative Coordinator

Health Information Specialist

Authorization Specialist

Financial Clearance Specialist III - PreArrival - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Patient Access Representative III - Duarte

Biller IV - HB Patient Financial Services - FT Days

Financial Clearance Specialist IV - Admitting - Full Time 8 Hour Variable Shift (Non Union)

Pharmacy Prior Authorization Specialist

Advanced Therapies Benefits Specialist (Financial Clearance)

Member Services Representative

Claims Specialist

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