Top 26 Prior authorization specialist Jobs in San Francisco, Ca

DME Documentation Criteria Reviewer
Hike Medical —San Francisco, CA
- $90,000 - $145,000 a year
- Full-time
- Hybrid work
- Mid-level
- Office
- Commercial
Prior Authorization Specialist
PHIL —San Francisco, CA
- $19 - $22 an hour
- Full-time
- Mid-level
- Office
- Reliable transportation
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
Medication Access Technician
University of California San Francisco —San Francisco, CA
- Full-time
- Spanish
- Writing skills
- Basic math
Clinical Informatics Specialist
Latent —San Francisco, CA
- $75,000 - $100,000 a year
- Full-time
- Continuous improvement
- Quality control
- Epic
Patient Records Abstractor 2
University of California San Francisco —Emeryville, CA
- Full-time
- Remote
- 5 years
- Data analysis skills
- Analysis skills
10d
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
Ambulatory Practice Coordinator 3
University of California San Francisco —Redwood City, CA
- Full-time
- Spanish
- Microsoft Excel
- Microsoft Outlook
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
Member Services Representative – Temporary Full Time
CCHP Health Plan —San Francisco Bay Area, CA
- $24.00 - $39.39 an hour
- 8 hour shift
- Spanish
- Research
- US work authorization
Quick Apply
MEDICAL BILLING AND COLLECTIONS SPECIALIST
American CareQuest, Inc. —Burlingame, CA
- $28 - $35 an hour
- Part-time
- Background check
- Mid-level
- Home Health
Quick Apply
11d
PACE REFERRAL TRACKING COORDINATOR
NORTH EAST MEDICAL SERVICES —Daly City, CA
- $30 an hour
- Full-time
- Customer service
- Mid-level
- High school diploma or GED
- Health insurance
- Dental insurance
7d
Electronic Health Record Analyst III - BID (Open & Promotional)
County of San Mateo —San Mateo, CA
- $146,120.00 - $182,582.40 a year
- Full-time
- Hybrid work
- Clinic experience
- Analysis skills
- Driving
- Retirement plan
Patient Access Representative Full Time
San Ramon Endoscopy Center (11643) —San Ramon, CA
- $25 - $30 an hour
- Full-time
- HIPAA
- High school diploma or GED
- Typing
- Health savings account
- AD&D insurance
6d
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
Customer Service Representative
QUIPT HOME MEDICAL INC —Walnut Creek, CA
- Microsoft Excel
- High school diploma or GED
- Typing
- Paid holidays
- Disability insurance
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
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
- Health insurance
Director of Customer Success
Valency Systems Inc. —Berkeley, CA
- Full-time
- Hybrid work
- US work authorization
- Senior level
- Commercial
Quick Apply
Professional Fee Coder - Analyst II (part-time / per diem)
University of California San Francisco —Emeryville, CA
- From $45 an hour
- Full-time
- Anatomy knowledge
- Mid-level
- Bachelor's degree

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DME Documentation Criteria Reviewer

Hike Medical
San Francisco, CA

Apply Now

Job Details

Full-time
$90,000 - $145,000 a year

Qualifications

Overseeing health insurance pre-certification
Medicare
Medicare coding guidelines
Managed care organization experience
CMS
Healthcare documentation compliance audits
Mid-level
CMS regulatory compliance
Medicare regulations
Utilization management
Document review
Insurance policy review
Centers for Medicare & Medicaid Services (CMS) billing regulations
Clinical documentation improvement
Red flag analysis
Clinical documentation standards
Documentation review
Documentation reviews

Full Job Description

About Hike Medical

Hike Medical is building the defining company in musculoskeletal care. We sit at the intersection of AI, robotics, and healthcare, operating across three product lines: a proprietary AI-vision platform that turns a 30-second, web-based foot scan into custom 3D-printed orthotics; an AI agent platform that automates the entire DME workflow from pre-visit processing through claims and revenue cycle; and SoleForge, our vertically integrated 3D-printing factory producing custom medical devices at a scale the industry has never seen.

Insoles today, full DME tomorrow, bionics by 2040. Custom insoles are just the wedge. Our long-term vision is bionics: AI-designed, robotically manufactured orthotic and prosthetic devices at scale, replacing a fragmented, manual industry that hasn’t changed in decades. Read the full vision at bionics2040.com.

We’re live across the industry’s largest national orthotics-and-prosthetics providers and tracking toward a $50M run rate by the end of 2026. We’ve stealthily raised $22M across Seed and Series A from top-tier investors who backed OpenAI, Anduril, and Mercury early, and we run a fast, results-first, high-ownership culture out of our SF Rincon Hill office.

About the Center of Excellence

The Center of Excellence is the intelligence engine of Hike. It owns the clinical and coding knowledge that powers every AI agent — producing agent guides per code block, setting evaluation standards, informing all compliance policies, and managing the human-in-the-loop team. CoE roles are the highest-leverage positions in the company: the documents and workflows you build determine how fast we expand into new device categories.

The Role

The DME Documentation Criteria Reviewer is the clinical analyst who turns medical necessity requirements into auditable, reviewable criteria sets. You review incoming patient documentation — physician notes, evaluations, prior authorization packets — against LCD criteria and payer policy, and identify exactly what is present, what is missing, and what can be obtained. You work inside our platform, and every review action you take becomes training data for the automation layer.

What You Will Do

Review patient documentation for each device category against CMS LCD criteria and payer-specific requirements.
Identify documentation gaps and generate structured deficiency notices to clinicians and prescribers.
Build and maintain criteria checklists per code block, aligned with the Clinical Intelligence Lead's agent guides.
Audit HITL team reviews for criteria accuracy and consistency.
Flag payer-specific deviations (e.g., UHC requirements that differ from Medicare) and document them in the policy library.
Collaborate with the Protocol Specialist to update criteria sets when LCDs change.
Support prior authorization packet assembly, ensuring each packet maps to the coverage criteria for the relevant payer.

What We Are Looking For

3+ years reviewing DMEPOS documentation in a clinical, billing, or utilization management role.
Solid understanding of CMS Local Coverage Determinations and Policy Articles for O&P and DME categories.
Experience with prior authorization at Medicare FFS and major commercial payers (UHC, Aetna, Cigna).
Detail-oriented, comfortable with structured checklists and building systematic review processes.
Familiarity with HCPCS L-code ranges for orthotics and prosthetics preferred.
Experience at a DMEPOS supplier, O&P company, or managed care organizatio

Compensation Range: $90K - $145K

Apply Now

Refine Your Search

prior authorization specialist jobs in san francisco, ca

DME Documentation Criteria Reviewer

Prior Authorization Specialist

Clinical Support Specialist

Medication Access Technician

Clinical Informatics Specialist

Patient Records Abstractor 2

Claims Resolution Specialist

Ambulatory Practice Coordinator 3

Organ Allocation Coordinator I

Member Services Representative – Temporary Full Time

MEDICAL BILLING AND COLLECTIONS SPECIALIST

PACE REFERRAL TRACKING COORDINATOR

Electronic Health Record Analyst III - BID (Open & Promotional)

Patient Access Representative Full Time

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

Customer Service Representative

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

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

Director of Customer Success

Professional Fee Coder - Analyst II (part-time / per diem)

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