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From Home Authorization Utilization Review Bcba Jobs in Riverside, CA

KPC Health

Utilization Review Tech

Santa Ana, CA · On-site

Utilization Review Technician Under direction of the Utilization Review Technician Supervisor, the ... data from various insurance providers and health plans regarding authorization and/or denials ...

KPC Global MSO

Utilization Review Tech

Santa Ana, CA · On-site

SUMMARY Under direction of the Utilization Review Technician Supervisor, the Utilization Review ... data from various insurance providers and health plans regarding authorization and/or denials ...

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

... from admission through discharge planning. The primary goal is to conduct daily inpatient reviews ... Apply LCD/NCD to pre-service authorizations when determining appropriate clinical tiers.

Prime Healthcare

Utilization Review RN

Ontario, CA

$71K - $104K/yr

Responsible for the quality and resource management of all authorizations and referrals with the ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

Responsibilities Responsible for the quality and resource management of all authorizations and ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

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From Home Authorization Utilization Review Bcba information

What is a from home Authorization Utilization Review BCBA?

A 'From Home Authorization Utilization Review BCBA' is a Board Certified Behavior Analyst (BCBA) who works remotely to review and authorize treatment plans for clients, typically in the field of applied behavior analysis (ABA). Their primary responsibility is to evaluate submitted treatment requests, ensure they meet clinical guidelines and insurance requirements, and approve or deny them accordingly. This role combines clinical expertise with administrative tasks and is essential for maintaining quality and compliance in ABA therapy services. Working from home allows BCBAs to perform these duties flexibly, using secure online systems to review documentation and communicate with providers.

What are the key skills and qualifications needed to thrive as a from home Authorization Utilization Review BCBA?

To thrive as a From Home Authorization Utilization Review BCBA, you need certification as a Board Certified Behavior Analyst (BCBA), a strong background in applied behavior analysis, and experience with clinical review processes. Familiarity with electronic health records (EHR), utilization management software, and insurance authorization systems is typically required. Strong analytical thinking, attention to detail, and effective communication are essential soft skills for collaborating remotely and ensuring accurate case evaluations. These skills enable efficient and evidence-based review of treatment requests, ensuring appropriate care and compliance with payer guidelines.

What are some common challenges faced by a from home Authorization Utilization Review BCBA, and how can they be managed?

A remote Authorization Utilization Review BCBA often encounters challenges such as limited direct client interaction, reliance on thorough documentation, and navigating varying payer requirements. Staying organized and maintaining clear, detailed case notes are crucial for accurate reviews and justifying treatment authorizations. Regular communication with clinical teams and payers, as well as utilizing secure telehealth and documentation platforms, can help manage these challenges. Being proactive about ongoing training in payer guidelines also ensures compliance and efficiency in the role.

What is the difference between From Home Authorization Utilization Review Bcba vs From Home Authorization Utilization Review Bcba?

AspectFrom Home Authorization Utilization Review Bcba

Since the comparison is with the same job title, there is no difference between From Home Authorization Utilization Review Bcba and itself. Typically, variations may exist based on employer or specific job duties, but the core credentials, work environment, and industry usage remain consistent for this role.

Can a From Home Authorization Utilization Review BCBA work remotely?

Yes, a From Home Authorization Utilization Review BCBA can work remotely, as many roles in behavioral health and utilization review are performed virtually. This position typically requires strong communication skills, certification, and familiarity with telehealth tools and electronic health records, allowing for flexible work environments.

Is utilization review work from home?

Utilization review roles, including those for BCBA professionals, are increasingly offered as remote positions, especially with the use of telehealth and digital documentation tools. Many employers allow work-from-home arrangements, but specific policies depend on the company and job requirements, such as certification and experience in behavioral health. Candidates should verify remote options during the application process or interview stage.

What cities near Riverside, CA are hiring for From Home Authorization Utilization Review Bcba jobs?

Cities near Riverside, CA with the most From Home Authorization Utilization Review Bcba job openings:

From Home Authorization Utilization Review Bcba jobs near you

Utilization Review Tech

Santa Ana, CA • On-site

KPC Health
Health Care and Social Assistance • 201 - 500 employees
Learn more about KPC Healthexternal

Other

Posted 24 days ago

Job description

Utilization Review Technician

Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for coordinating phone calls, clinical requests, upkeeps data entry, organizes denials and mailing/faxing appeals, tracking data from various insurance providers and health plans regarding authorization and/or denials, expedite reviews and documentation to insurance providers. Monitors patient charts and records to provide to responsible parties and request for authorization for hospital admission. Reviews treatment plans and status of approvals from insurers. Collects and compiles data as required and according to applicable policies and regulations. Performs administrative duties for the Utilization Management Department, and directed in several aspects of duties. Position is non-RN/LVN.

Requirements
  • Ability to establish and maintain effective working relationships across the Health System
  • Ability to interpret and understand various medical insurance plans and make accurate determinations regarding coverage
  • Follow up with insurance companies regarding the status of outstanding claims and necessary steps for resolution
  • Answer and review pertinent insurance correspondence to ensure complete and accurate reimbursement for medical claims
  • Responsible for working payer correspondence, edits and aged account receivable, and identifying and correcting billing errors
  • Pull daily reports utilizing Microsoft Excel and providing correct correspondence to payer
  • Research payer rules and regulations to maintain current payer knowledge
  • Comply with HIPAA and other compliance requirements to protect patient confidentiality
  • Manage data in internal and external databases with accuracy
  • Provide high-level administrative support and assistance to the Director and Supervisor or other assigned leadership staff
  • Perform clerical and administrative tasks including drafting letters, memos, invoices, reports, and other documents for senior staff
  • Prepare patient charts for medical audits
Education & Experience Requirements:
  • High School Diploma
  • Healthcare experience strongly preferred
Skills & Abilities Requirements:
  • Excellent verbal and written communication skills
  • Excellent organizational skills and attention to detail
  • Excellent time management skills with a proven ability to meet deadlines
  • Ability to function well in a high-paced and at times stressful environment
  • Extensive knowledge of office administration, clerical procedures, and recordkeeping systems
  • Able to type minimum of 50 words per minute
  • Knowledge of CMS, State Regulations, URAC and NCQA guidelines preferred.
  • ICD-10 and CPT coding experience a plus
  • Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system a plus
  • Extremely proficient with Microsoft Office Suite or similar software with the ability to learn new or updated software
  • Medical Terminology preferred
Physical Requirements:
  • Body Positions: Sitting and standing for prolonged periods.
  • Body Movements: Arm and hand dexterity.
  • Body Senses: Must have command of close and distant sight, color perception and hearing.
  • Strength: Ability to lift and move up to 25-pounds.
Working Environment:
  • Work in an office, where the climate is controlled.
  • OSHA exposure category: II
  • Category I – Position includes tasks that involve exposure to Blood borne Pathogens.
  • Category II – Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks.
  • Category III – Positions includes tasks that do not involve exposure to Bloodborne Pathogens. This position would not be required to perform Category I tasks.
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About KPC Health

Sourced by ZipRecruiter

KPC Health has an integrated approach to serving the people of Riverside, San Bernardino and Orange County. Our acute care medical centers provide high quality, comprehensive and affordable healthcare for the entire family. For us, healthcare is not just about caring for our patients, but also about investing in the people throughout our communities. We are one team with one mission and that mission is for all our patients, and their families to Enjoy Life in Great Health.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Santa Ana, CA, US

Year founded

2004

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