Top 34 Prior authorization specialist Jobs in San Pedro, Ca

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
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
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
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4d
Patient Operations Specialist
Harbor Community Clinic —San Pedro, CA
- $24 - $27 an hour
- Overtime
- Background check
- Spanish
- BLS Certification
Quick Apply
Release of Information Specialist
Vital Holdings LLC —Los Angeles, CA
- HIPAA
- Windows
- High school diploma or GED
Quick Apply
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
Payor Relations Specialist - Inpatient Rehab
California Rehabilitation Institute —Los Angeles, CA
- $78,000 - $115,000 a year
- Full-time
- LVN
- RN License
- Mid-level
- Dental insurance
- Paid time off
Quick Apply
12d
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 Services Specialist
TEEMA Group —Los Angeles, CA
- $25 - $27 an hour
- Full-time
- Physical & Rehabilitation Medicine
- HIPAA
- Mid-level
Quick Apply
8d
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
Referral Clerk
T.H.E. Health & Wellness Centers —Los Angeles, CA
- $22 - $25 an hour
- Full-time
- Bilingual
- Spanish
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
Workers’ Compensation Administrative Coordinator
Southern California University —Whittier, CA
- $25 - $27 an hour
- Full-time
- Microsoft Outlook
- Computer literacy
- Mid-level
Quick Apply
Surgery Coordinator
Commons Clinic —Lakewood, CA
- $24 - $26 an hour
- Full-time
- Surgery
- Mid-level
- Administrative experience
- Free parking
- Health savings account
Quick Apply
13d
Front Office Medical Receptionist
Commons Clinic —Long Beach, CA
- $17 - $20 an hour
- Full-time
- HIPAA
- Clinic
- Perioperative Care
- Free parking
- Health savings account
Quick Apply
13d
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
Referrals Coordinator (Temp 6 months)
Clinica Romero —Los Angeles, CA
- $23.51 an hour
- Full-time
- Spanish
- HIPAA
- English
- Health insurance
Quick Apply
Scheduling Coordinator
TEEMA Group —Los Angeles, CA
- $20 - $25 an hour
- Full-time
- Spanish
- HIPAA
- English
Quick Apply
8d
Epic Ambulatory Bones Application Engineer Specialist - 6079188
Accenture —Los Angeles, CA
- $47.85 - $57.85 an hour
- Full-time
- Remote
- 5 years
- High school diploma or GED
- US work authorization
- Disability insurance
- Health insurance
Senior IT Systems Engineer I
Rocket Lab Corporation —Long Beach, CA
- $115,000 - $140,000 a year
- Azure
- 5 years
- Office
Quick Apply

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

Keck Medical Center of USC -
Los Angeles, CA

Apply Now

Job Details

Full-time
$25.00 - $39.69 an hour

Qualifications

Fire Safety Certification
Research
High school diploma or GED

Full Job Description

The Clinical Authorization Specialist will take the lead in securing medical authorizations from third party payers (commercial and government) for outpatient clinic, inpatient admission, ancillary services and/or chemotherapy and other infused treatments as needed in assigned service line. The Specialist will be instrumental in obtaining written documentation, submitting tracking, reporting and documenting outcomes of each authorization request. The Specialist will be in a position to interface directly with medical/clinical staff and pharmacy to ensure a seamless process to the patients receiving treatment.

The Oncology Authorization Specialist will take the lead in securing medical authorizations from third party payers (commercial and government) for chemotherapy treatments. The Specialist will be instrumental in obtaining written documentation, tracking, and reporting outcomes of each authorization request. The Specialist will be in a position to interface directly with medical staff and pharmacy to ensure a seamless process to the patients receiving chemotherapy treatments. This position will report to the Supervisor of Clinical Authorizations and will assist in the operation of the Norris Clinical Authorization Center.

Essential Duties:

Actively obtain written clinical documentation for chemotherapy authorizations in Keckcare for authorization submission from Medical/Nursing Staff
Submit pre-certification/pre determination documentation to third party payers/payers insurance carrier for authorization with correct CPT and ICD coding
Research payers medical policy requirements for chemotherapy treatment authorizations and understand process for submitting pre-certification/pre- determination requests
Utilize Excel Macro tracking log to document authorization requests, follow-up on items and provide outcomes to the Supervisor daily, prior to end of shift.
Follow-up on outstanding authorization requests and on medical documentation requests in a timely manner.
Enroll patients in manufacturer patient assistance programs as needed and follow-up regarding enrollment and/or medication reimbursements
Communicate with a medical/clinical/pharmacy staff and patients on authorization status/outcome.
Employ compliance checker for Medicare eligible chemotherapy/infusion treatment authorizations and scan/email ABNS to front area reception for signatures as needed.
Coordinate with Director on denied or disputed claims to obtain documentation to support chemotherapy treatment
Exhibit sensitivity to the patients at all times concerning privacy and confidentiality while accessing medical records for chemotherapy treatments to process authorizations requests
Scan all authorizations into Keck care under the respective patient accounts and if applicable, forward authorized orders to pharmacy for dispensing
Maintain medical policy coverage binder and keep updated with new policies and forms regarding medications FDA indicated usage and authorization requirements.
Document authorization outcome in all financial systems.

Performs other duties as assigned.

Required Qualifications:

Req High school or equivalent Or equivalent evidence in file.
Req 2 years of experience in a hospital, medical office/doctor’s office or working for a health insurer required.
Req Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills

Preferred Qualifications:

Pref Specialized/technical training Vocational Nursing Degree.
Pref Oncology experience is preferred
Pref Medical prior authorizations or claims experience in a managed care setting highly preferred
Pref Knowledge of the health insurance industry and claims processing a plus
Pref Licensed Vocational Nurse - LVN (CA DCA)

Required Licenses/Certifications:

Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The hourly rate range for this position is $25.00 - $39.69. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to the Background Screening Policy Appendix D for specific employment screen implications for the position for which you are applying.

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at [email protected] . Inquiries will be treated as confidential to the extent permitted by law.

Notice of Non-discrimination
Employment Equity
Read USC’s Clery Act Annual Security Report
USC is a smoke-free environment

If you are a current USC employee, please apply to this USC job posting in Workday by copying and pasting this link into your browser:

https://wd5.myworkday.com/usc/d/inst/1$9925/9925$147564.htmld

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Refine Your Search

prior authorization specialist jobs in san pedro, ca

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)

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

Patient Operations Specialist

Release of Information Specialist

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

Payor Relations Specialist - Inpatient Rehab

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

Patient Services Specialist

Claims Specialist

Referral Clerk

Workers’ Compensation Administrative Coordinator

Surgery Coordinator

Front Office Medical Receptionist

Advanced Therapies Benefits Specialist (Financial Clearance)

Member Services Representative

Referrals Coordinator (Temp 6 months)

Scheduling Coordinator

Epic Ambulatory Bones Application Engineer Specialist - 6079188

Senior IT Systems Engineer I

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