Prior Authorization Specialist: Healthcare Claims & Compliance
UCLA Health
UCLA Health is seeking a health services professional to manage urgent, routine, pre-service, and retro authorization requests. You will process prior authorizations for claims adjudication using various business apps and ensure timely, accurate determinations per clinical protocols. The role requires strong communication, organizational and problem-solving skills, with the ability to work across departments. UCLA Health offers a stable environment in Southern California. #J-18808-Ljbffr UCLA Health
$40 per hour
Job Title: Intake Authorization Specialist Job Type: Full-time Pay: up to $40.00 per hour Expected Hours: 40 hours... ...system. Adjudicate pharmacy benefit claims, including Medicare Part D. Qualifications Required: Prior experience in home infusion. Preferred: Familiarity...ClaimsHourly payFull timeRemote work- ...information. Communicate with IPA regarding prescription claim or prior authorization status. Inventory management including placing orders,... ...than 50 years, we've provided high-quality, low cost healthcare and preventative education for all. We are an Equal Opportunity...ClaimsLocal area
- ...relationships with the healthcare provider network in a... ...resources, referral, claim processing, portal access... .... Resolves complex authorization or claims issues.... ...meet standards. Monitors compliance with CAP. Uses databases... ...and experience; prior experience with physician...ClaimsContract workWork at office
$33 - $36 per hour
...AmeriPharma is a rapidly growing healthcare company where you will have... ...analytical Reimbursement Specialist III to join our dynamic team... ...at submitting complex claims and appeals. If you are a proactive... ...as needed. Ensures compliance with all payer rules, regulations...ClaimsHourly payMonday to Friday$205k - $375k
Healthcare Regulatory Litigation Associate - 2-4 Years of ExperienceCalifornia (Los Angeles... ...healthcare regulations and advise clients on compliance and riskParticipate in administrative... ...appealsGovernment investigationsFalse Claims Act mattersFraud and abuse enforcementHealthcare...ClaimsRemote workFlexible hours- ...providers and stakeholders across eligibility, benefits, claims, and authorizations. You will ensure compassionate, accurate support across channels... ...Medi-Cal and PASC programs, handling inquiries with HIPAA compliance, documenting interactions, and triaging requests to...Claims
- CHA Hollywood Presbyterian Medical Center seeks an Authorization Support professional to perform telephone and online authorizations for routine... ...information, obtain approvals from payors, and resolve pended claims while ensuring patient data confidentiality. #J-18808-Ljbffr...Claims
- AmeriPharma is seeking a highly skilled Reimbursement Specialist III in Beverly Hills, CA. You will play a key... ...The ideal candidate has a deep understanding of healthcare billing and coding, and can handle complex claims and appeals with minimal supervision. #J-18808-Ljbffr...Claims
$17 - $18.15 per hour
...We recognize that healthcare requires a human... ...Access Associate Specialist plays a critical... ...integrity, regulatory compliance, and a positive... ..., and first-pass claim rates. Serves as... ...patient accounts prior to patient visits... ...reside and are authorized to work within the...ClaimsWork at officeLocal areaRemote work$20 - $28 per hour
...our clients’ personal injury claims. The ideal candidate is experienced... ...-paced legal environment. Prior experience in personal injury... ...from hospitals, clinics, and healthcare providers Track and follow... ...on file Maintain strict compliance with HIPAA and firm...ClaimsHourly payFull timeWork at officeImmediate startRelocationMonday to FridayShift workAfternoon shiftEarly shift$158.39k - $185.58k
...patients, caregivers, and healthcare providers in navigating insurance... ..., educates stakeholders on prior authorization and billing processes, and... ...access barriers and denied claims; escalate complex... .../coding processes HIPAA compliance and healthcare regulatory knowledge...Claims$400k
...involving major civic, infrastructure, healthcare, energy, and commercial developments.... ...orders, payment issues, design-related claims, defaults, and project performance problems... ...with procurement-related issues, contract compliance, and other project delivery concerns \n...ClaimsContract workFor contractorsRemote work$18.92 - $23.46 per hour
Recognized as a “Best Place to Work Modern Healthcare” - Join a team where people come first... ...and accuracy, identify and audit claims, ensure all revenue opportunities are... ...and medical third-party claims. Obtain prior authorizations; initiate requests, follow up to provide...ClaimsFull timeContract workTemporary workLocal areaImmediate startFlexible hours$90k
...Medtronic is a global leader in healthcare technology with a Mission to... ...Senior Stapling Robotics Specialist is a key technical and... ...specific to each role.U.S. Work Authorization & SponsorshipAt Medtronic, we... ...receive a suspicious message claiming to be from Medtronic, do not...ClaimsH1bWork at officeLocal areaImmediate startRemote workFlexible hoursShift work$47.84k
...Job Summary The Authorization Technician II supports... ...Management (UM) Specialist by handling all... ...and Weekly Compliance Reports. In addition... ...requests using the claims and verify... ...experience in UM/Prior Authorization. Skills... ...Data Entry, Claims, Healthcare, Administrative,...ClaimsFull timeWork at officeWeekend work$121.06k
...Technology Strategy Lead - Claims, Finance, HR, Legal & Compliance Job Category:... ...maintaining compliance with healthcare payer and regulatory requirements... ...health, pharmacy, UM authorizations, quality oversight,... ...operations enablement, Prior Authorization Interoperability...ClaimsFull time- A healthcare services provider near West Hollywood is seeking a Travel Health Information Services Technician. The role involves prioritizing customer requests, ensuring compliance with HIPAA regulations, and utilizing EPIC's Release of Information module effectively....Daily paidFull timeContract workPart timeShift work
$76k - $199.6k
...involved in manufacturing, testing, or compliance, your contribution will directly impact... ...Service and/or Account Management Relevant Healthcare/Scientific roles (e.g., RN, Pharmacist,... .../or eligibility. Candidates must be authorized to be employed in the U.S. by any...Permanent employmentFull timeH1bLocal areaRemote workVisa sponsorshipWork visaRelocation package- .... (UAII) is seeking a Program Billing Specialist to oversee accurate billing, claims submission, and revenue cycle activities for its healthcare and community programs in Los Angeles.... ...payers to ensure timely reimbursement and compliance with applicable requirements. The role...Claims
- ...Description PURPOSE: The Prior Authorization Nurse will document and... ...primary care physicians and specialists Documentation of denial... ...California’s federally funded healthcare programs: Medi-Cal,... ...management, care coordination, and claims processing services to...ClaimsContract work
$111.6k - $139.4k
...developing, maintaining, and executing healthcare analytics and reporting solutions that... ...intelligence tools.Analyze healthcare claims, EMR, and operational datasets to... ...care management, utilization management, prior authorization, HCC risk adjustment, population health...ClaimsFull time$31.51 - $62.64 per hour
University of California - Los Angeles Health is seeking a Claims Quality Auditor to take on a vital role in a leading health organization... ...will perform daily audits on claims, ensuring accuracy, compliance, and adherence to policies. Candidates must have a high school...ClaimsHourly pay- ...Counsel About the Company Healthcare company seeking an interim in... ...contracts, litigation, and claims, as well as labor and... ...enterprise training on legal and compliance matters. Applicants for the Interim... ...to practice law. While prior experience with the specific...ClaimsInterim role
- COPE Health Solutions in New York or Los Angeles is seeking an Analyst, Healthcare Financial Analytics to join the finance team as a junior actuary embedded role. You will analyze claims and healthcare data across ACOs and Health Plans, delivering decision-ready insights...Claims
- ...patient relations (scheduling, complaints, communication), and compliance (OSHA, HIPAA) to ensure smooth practice flow, efficiency, and positive... ...~ Financial Oversight: Managing billing, insurance claims, collections, payroll, budgeting, and financial reporting....Claims
- Astrana Health in Monterey Park, CA is seeking a Lead - Claims Examiner to report to the Sr. Manager - Claims. This hybrid role combines... ...improvements. You will mentor staff, monitor audits, drive compliance with CMS and coding standards (ICD-10, CPT, HCPCS), and coordinate...ClaimsWork at officeWork from home
$130k - $190k
...Benefits include: ~ PPO Healthcare, vision, dental, life insurance... ...transactions to ensure compliance with the Stark Law, Anti-Kickback Statute, False Claims Act, and state analogs, as well... ...background checks with your authorization. Jobot will consider qualified...ClaimsFor contractorsLocal area- ...Insurance Verification Specialist to join a growing U.S.-based healthcare practice.If you have... ...completeness, and HIPAA compliance.What You'll DoVerify... ...network coverageIdentify prior authorization requirementsDocument... ...Weave experienceInsurance claims and follow-up...ClaimsImmediate start
$400k
...involving major civic, infrastructure, healthcare, energy, and commercial developments.... ...orders, payment issues, design-related claims, defaults, and project performance problems... ...with procurement-related issues, contract compliance, and other project delivery concerns...ClaimsContract workFor contractorsRemote work- Authorization Monitoring and Tracking Specialist job at Allcare Home Health. Glendale, CA. Position Summary: The Authorization... ...-paced environment. Preferred: Prior experience as an Authorization... ...Assistant in home health or healthcare setting. Familiarity with CMS and...Work from home
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