Top 23 Prior authorization specialist Jobs in Danville, Ca

Claims Resolution Specialist
Integrated Pain Management Medical Group, Inc. —Walnut Creek, CA
- $28 - $35 an hour
- Full-time
- HIPAA
- Research
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Customer Service Representative
QUIPT HOME MEDICAL INC —Walnut Creek, CA
- Microsoft Excel
- High school diploma or GED
- Typing
- Paid holidays
- Disability insurance
Quick Apply
DME Documentation Criteria Reviewer
Hike Medical —San Francisco, CA
- $90,000 - $145,000 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Commercial
Medical Coordinator - Behavioral Health
Solomon Medical —Hayward, CA
- $25 - $30 an hour
- Full-time
- Hybrid work
- Nursing
- Skilled nursing facility
- Surgery
- Health savings account
- Health insurance
Quick Apply
2d
Organ Allocation Coordinator I
Donor Network West —San Ramon, CA
- $25.24 - $31.55 an hour
- Weekends as needed
- Remote
- Customer service
- Mid-level
- Continuous improvement
Quick Apply
Temporary - Ambulatory Care - Pharmacy Technician - Medication Access Specialist - OSC Pharmacotherapy Clinic - Part Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $38.04 - $51.35 an hour
- 8 hour shift
- Clinic experience
- Mid-level
- 3 years
Temporary - Ambulatory Care - Pharmacy Technician - Medication Access Specialist - OSC Pharmacotherapy Clinic - Full Time - 8 Hour - Days
John Muir Health —Walnut Creek, CA
- $38.04 - $51.35 an hour
- 8 hour shift
- Mid-level
- Outpatient experience
- 3 years
Cancer Care Patient Administrative Specialist II - Admin Float Pool/New Patient Scheduling
Stanford Health Care —Newark, CA
- $32.56 - $36.66 an hour
- Full-time
- Mid-level
- Windows
- High school diploma or GED
Cancer Center New Patient Administrative Specialist II
Stanford Health Care —Newark, CA
- $32.56 - $36.66 an hour
- Full-time
- Mid-level
- Windows
- High school diploma or GED
Operations Specialist, Experienced
Blue Shield of California —Oakland, CA
- $32.03 - $48.04 an hour
- Full-time
- Hybrid work
- Background check
- Microsoft Excel
- Microsoft Outlook
- Work from home
11d
Medical Front Desk Specialist
Vascular Surgery —San Leandro, CA
- $25 an hour
- Overtime
- Spanish
- Clean driving record
- Ability to walk for extended periods
- Health insurance
- Dental insurance
Quick Apply
RCM Billing Specialist
Paradigm Oral Surgery —Pleasanton, CA
- Full-time
- Computer literacy
- HIPAA
- Mid-level
- Health savings account
- Paid holidays
Quick Apply
1d
Operations Specialist, Senior
Blue Shield of California —Oakland, CA
- $81,950 - $122,870 a year
- Full-time
- Hybrid work
- Background check
- Microsoft Excel
- Microsoft Outlook
- Work from home
11d
Front Office II
Tri-Valley Oral Surgery & Dental Implants —San Ramon, CA
- $22 - $26 an hour
- Full-time
- Dental office
- Surgery
- Writing skills
- Health insurance
- Dental insurance
Quick Apply
Clinical Support Specialist
PHIL —San Francisco, CA
- $26 - $28 an hour
- Full-time
- Remote
- Continuous improvement
- 2 years
- Communication skills
- Health insurance
- Dental insurance
Quick Apply
Clinical Informatics Specialist
Latent —San Francisco, CA
- $75,000 - $100,000 a year
- Full-time
- Continuous improvement
- Quality control
- Epic
Patient Auth and Referral Specialist I
CareMore Health Management Services, LLC —San Francisco, CA
- $19.80 - $29.70 an hour
- Full-time
- Medical office experience
- HIPAA
- High school diploma or GED
Quick Apply
3d
Director of Customer Success
Valency Systems Inc. —Berkeley, CA
- Full-time
- Hybrid work
- US work authorization
- Senior level
- Commercial
Quick Apply
5d
Software Engineer (Agent) Onsite (San Francisco, CA)
Parakeet Health —San Francisco, CA
- $150,000 - $200,000 a year
- Full-time
- Mid-level
- Office
- In-person
- Commuter assistance
- Dental insurance
Member Services Representative – Temporary Full Time
CCHP Health Plan —San Francisco Bay Area, CA
- $24.00 - $39.39 an hour
- 8 hour shift
- Spanish
- English
- Research
Quick Apply

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Claims Resolution Specialist

Integrated Pain Management Medical Group, Inc. -
Walnut Creek, CA

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Job Details

Full-time
$28 - $35 an hour

Benefits

Paid holidays
Health insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching
Employee discount

Qualifications

High school diploma or GED

Full Job Description

The Claims Resolution Specialist is responsible for the day-to-day investigation and resolution of claim rejections, denials, edits, and reimbursement issues across a multi-site, multi-specialty healthcare organization specializing in pain management, physical medicine, and functional rehabilitation services.

Working closely with the Pre-Billing, Accounts Receivable (A/R), Denials Management, Coding, and Revenue Integrity teams, this position performs detailed claim reviews, researches payer requirements, corrects claim errors, and facilitates timely claim resubmission and payment. The Claims Resolution Specialist serves as a key resource in resolving billing issues and ensuring claims are processed accurately and efficiently.

This is a remote role. We are only hiring in the following states: AZ, CA, NM, NV, OR, TX and WA.

What you will do:

Claims Resolution & Follow-Up

Investigate and resolve claim rejections, denials, and payer edits identified before or after claim submission.
Review claim history, payer correspondence, medical records, authorizations, and supporting documentation to determine the cause of claim issues.
Correct billing, coding, demographic, authorization, and insurance-related claim errors as appropriate.
Process claim corrections, adjustments, resubmissions, and reconsideration requests in accordance with payer guidelines.
Perform payer research and communicate directly with insurance carriers to resolve claim processing issues.
Monitor assigned work queues and ensure timely resolution of outstanding claims.
Escalate complex reimbursement, coding, or compliance issues to senior team members.

Denial Management Support

Partner with A/R and Denials Management teams to resolve denied and underpaid claims.
Assist in preparing appeal documentation and supporting materials for denied claims.
Identify recurring denial patterns and communicate findings to the Senior Claims Resolution Coordinator.
Maintain accurate documentation of denial resolution activities and payer communications.
Support efforts to reduce preventable denials and improve reimbursement outcomes.

Pre-Billing & Revenue Cycle Collaboration

Work closely with the pre-billing team to identify and correct claim issues prior to submission.
Review claims for completeness and compliance with payer billing requirements.
Verify insurance information, authorizations, referrals, diagnosis coding, procedure coding, and modifier usage.
Collaborate with coding and clinical teams to obtain information needed for claim resolution.
Assist with reducing claim holds and billing delays.

Audit & Compliance Support

Participate in routine claim quality reviews and internal audit activities.
Ensure claim corrections comply with payer regulations, organizational policies, and billing guidelines.
Support Revenue Integrity initiatives through accurate claim review and documentation.
Maintain knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial payer requirements.
Adhere to HIPAA, CMS, and organizational compliance standards.

Documentation & Reporting

Maintain detailed documentation of claim investigations, resolutions, payer communications, and follow-up activities.
Track assigned workloads and resolution outcomes.
Assist with compiling information for denial trend reporting and operational reviews.
Provide feedback regarding workflow issues contributing to claim errors or payment delays.
Assumes other responsibilities as appropriate to the position and organizational needs

Qualifications:

High School Diploma or equivalent required.
Associate degree in Healthcare Administration, Medical Billing and Coding, or related field preferred.
Minimum 2-4 years of experience in medical billing, claims resolution, denial management, accounts receivable, or healthcare revenue cycle operations.
Working knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial insurance billing requirements.
Knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and medical terminology.
Experience researching and resolving denied or rejected claims.
Strong analytical and critical thinking skills.
Ability to manage multiple priorities and meet productivity expectations.

Compensation Range:

$28.00 to $35.00 Hourly

All compensation ranges are posted based on internal equity, job requirements, experience, and geographical locations.

Why You'll Love Working Here:

Amazing work/life balance
Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO)
401(K) Plan with Employer Matching
License & Tuition Reimbursements
Paid Time Off
Holiday Pay & Floating Holiday
Employee Perks and Discount Programs
Supportive environment to help you grow and succeed

Boomerang Healthcare (BHC) is a multidisciplinary and comprehensive team of experienced, committed healthcare providers that treat pain. Our team of doctors approaches each patient with one goal in mind: to help patients return to normal daily activities. We work with our patients to identify the cause of their pain and create a personalized treatment plan, recognizing that no two patients are alike, and neither is their pain. Our providers create a comprehensive care plan, then monitor, manage and coordinate patient access to health services at BHC.

Boomerang Healthcare strives to be a diverse workforce that reflects, at all job levels, the patients we serve. We are an equal opportunity employer. Boomerang Healthcare is committed to compliance with the American Disabilities Act. If you require reasonable accommodation during the application process or have a question regarding an essential job function, please contact us.

Monday-Friday, 8am-5pm
40

Quick Apply

Refine Your Search

prior authorization specialist jobs in danville, ca

Claims Resolution Specialist

Customer Service Representative

DME Documentation Criteria Reviewer

Medical Coordinator - Behavioral Health

Organ Allocation Coordinator I

Temporary - Ambulatory Care - Pharmacy Technician - Medication Access Specialist - OSC Pharmacotherapy Clinic - Part Time - 8 Hour - Days

Temporary - Ambulatory Care - Pharmacy Technician - Medication Access Specialist - OSC Pharmacotherapy Clinic - Full Time - 8 Hour - Days

Cancer Care Patient Administrative Specialist II - Admin Float Pool/New Patient Scheduling

Cancer Center New Patient Administrative Specialist II

Operations Specialist, Experienced

Medical Front Desk Specialist

RCM Billing Specialist

Operations Specialist, Senior

Front Office II

Clinical Support Specialist

Clinical Informatics Specialist

Patient Auth and Referral Specialist I

Director of Customer Success

Software Engineer (Agent) Onsite (San Francisco, CA)

Member Services Representative – Temporary Full Time

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