Add your latest resume to match with open positions.

3 results for Denials Specialist in Thousand Oaks, CA

Authorizations Specialist

Los Angeles, CA
onsite
Temporary / Contract
25 - 27 USD / Hourly
We are seeking a detail-oriented and patient-focused Authorizations Specialist to join our hospital team. In this role, you will be responsible for obtaining and managing insurance authorizations for outpatient and inpatient services while ensuring compliance with payer requirements. The ideal candidate has strong knowledge of medical insurance, excellent communication skills, and the ability to thrive in a fast-paced healthcare environment. Essential Responsibilities: * Obtain prior authorizations and pre-certifications from commercial, Medicare, Medicaid, and managed care insurance plans.* Verify patient insurance eligibility, benefits, and coverage requirements.* Review physician orders and clinical documentation to ensure authorization requests meet payer guidelines.* Submit authorization requests accurately and follow up to secure timely approvals.* Communicate authorization status to physicians, clinical staff, scheduling teams, and patients.* Monitor pending authorizations and resolve issues that may delay patient care.* Document all authorization activity in the electronic medical record (EMR) and other applicable systems.* Coordinate with insurance companies to appeal denied or delayed authorization requests when appropriate.* Maintain current knowledge of payer policies, authorization requirements, and regulatory guidelines.* Provide exceptional customer service while maintaining patient confidentiality in accordance with HIPAA regulations.* Perform other duties as assigned.
2026-07-13T00:00:00Z

Enrollment Specialist

Santa Barbara, CA
onsite
Temporary / Contract
24.7 - 28.6 USD / Hourly
We are looking for an Enrollment Specialist to support client access to healthcare-related community services in Santa Barbara, California. This Long-term Contract position focuses on enrollment coordination, eligibility monitoring, documentation accuracy, and service quality oversight for individuals receiving homeless services. The person in this role will help maintain compliance with program standards while partnering with staff to improve workflows and support timely reimbursement activities. Responsibilities:• Guide eligible clients through enrollment into programs, completing and processing required forms accurately and on time.• Partner with homeless services teams to monitor ongoing client eligibility, update records, and help prevent interruptions in approved coverage or support.• Examine case management documentation to confirm services are properly recorded, clinically appropriate, and aligned with reimbursement standards.• Coordinate with program and case management staff to track authorization timelines and support timely submission of renewal requests before expiration.• Review claims-related records and supporting documentation in the Health Management Information System to promote accurate billing and complete file maintenance.• Participate in meetings with internal teams and external partners to address service quality, operational needs, and continuous improvement efforts.• Provide additional administrative and program support as needed to assist with successful day-to-day execution of CalAIM initiatives.
2026-07-28T00:00:00Z

Medical Billing Specialist

Van Nuys, CA
onsite
Temporary / Contract
25 - 30 USD / Hourly
A leading hospital in the Valley is seeking a detail-oriented Medical Billing Specialist to join its revenue cycle team. This role is responsible for ensuring accurate and timely claim submission, follow-up, and resolution of managed care billing issues. The ideal candidate will have strong knowledge of medical billing processes, payer requirements, and accounts receivable follow-up within a hospital environment. Key Responsibilities:<ul><li>Demonstrate the ability to determine the accuracy of pertinent medical, coding, eligibility, authorization, demographic, and financial information, and make any required corrections.</li><li>Determine payer documentation requirements for payment and ensure all necessary supporting documentation is available for claim submission. </li><li>Transmit and submit clean claims to payers within three working days of receipt, while maintaining a productivity standard of 200 claims per day. </li><li>Update the computer system to reflect claim submission and transmission activity. </li><li>Review payer correspondence and provide corrections and/or additional documentation within three working days. </li><li>Review payment data for suspensions, underpayments, and denials, and submit appropriate responses, including corrected insurance forms and rebills as needed. </li><li>Review bi-monthly accounts receivable reports to identify claims that have been submitted but remain unresolved or unacknowledged, as well as claims that have not yet been submitted, and take appropriate action to ensure timely resolution. </li><li>Prepare adjustments needed to ensure account balances reflect payable amounts and forward them to management for review and authorization. </li></ul>
2026-07-28T00:00:00Z