Role Description The Prior Authorization Specialist will join Zócalo Health during a period of rapid growth and increasing operational complexity. This role exists to help scale and execute a community-oriented primary care model that delivers measurable outcomes for high-need members and health plan partners. As a key member of our rapidly expanding team, you will drive the prior authorization process by managing timely, detailed correspondence with payers and healthcare providers to ensure strict adherence to guidelines. This role requires exceptional attention to detail in maintaining accurate, compliant, and up-to-date patient records. This position reports to the Authorizations Manager. The Prior Authorization Specialist will contribute in the following ways: - Authorization Submission: Prepare and submit detailed pre-authorization requests to insurance payers, ensuring all required medical documentation, chart notes, CPT/ICD codes, and supporting documentation are accurate and submitted within required timelines. - Liaison & Follow-Up: Act as the central point of coordination between healthcare providers, patients, internal operational teams, and insurance companies to track prior authorization status, clarify payer requirements, and resolve outstanding requests. - Authorization Tracking & Record Keeping: Maintain accurate prior authorization records within Zocalo Electronic Medical Record, including approvals, denials, effective dates, units/visits, payer communications, and required follow-up actions. - Denial Management: Research and assist in resolving prior authorization denials, missing information requests, payer discrepancies, and appeals in a timely manner. - Cross-Functional Collaboration: Collaborate closely with intake, clinical, billing, and payer operations teams to support timely authorization processing and reimbursement readiness. Qualifications - High school diploma or equivalent required. - 1+ year of prior authorization experience. - Medical & Insurance Knowledge: Fluency in medical terminology and a solid understanding of major payer guidelines. - Strong organizational skills with the ability to manage multiple priorities and high-volume workflows. - Ability to maintain accuracy, confidentiality, and compliance with HIPAA requirements in a remote work environment. - Strong written and verbal communication skills. Requirements - Direct experience with Medi-Cal Managed Care Plans. - Experience supporting Enhanced Care Management (ECM), Community Health Worker (CHW), and Community Support (CS) Services. - Experience working with electronic health record and practice management systems, including Athena. - Strong understanding of prior authorization workflows, including clinical review, coding accuracy, submission, denial management, appeals, and follow-up. Benefits - Competitive salary: $25 per hour. - Equity compensation package. - Comprehensive benefits including medical, dental, and vision. - 401k. - Generous PTO policy (up to 15 days per year for FT employees). - $1,000 home office stipend. - We provide the equipment needed for this role. - Opportunity for rapid career progression with plenty of room for personal growth.

Role Description Wir suchen Sie für unser wachsendes Team ab sofort neue Mitarbeiter (w/m/d) für die kieferorthopädische Abrechnung. - Gesucht werden ZFA und ZMV mit sehr guten Abrechnungskenntnissen in BEMA und GOZ. Qualifications - Abgeschlossene Ausbildung zur ZFA bzw. Aufstiegsfortbildung zur ZMV - Gute Kenntnisse in der kieferorthopädischen Abrechnung (BEMA/GOZ) - Professioneller Umgang mit mindestens einem der gängigen Praxissysteme, z. B. Ivoris, DS-WIN-Plus, Charly, o. a. - Selbstständiges, strukturiertes und sorgfältiges Arbeiten - Sehr gute kommunikative Fähigkeiten in Wort und Schrift - Teamplayer, Engagement und freundliches Auftreten Benefits - Unbefristeter Arbeitsvertrag - Leistungsorientierte Bezahlung plus attraktive Zulagen - Geregelte Arbeitszeiten im Voll- oder Teilzeitbereich - Life-Balance im Home-Office - IT-Ausstattung des Home-Office durch dentisratio - Moderne Arbeitsplätze - Workshops und Weiterbildungen - Fahrtkostenerstattung - Teamevents Company Description Zahnärzte wollen Menschen helfen und ihre Lebensqualität verbessern. Doch notwendige Aufgaben wie Verwaltung und Abrechnung rauben ihnen und dem Praxispersonal Zeit, die in Patienten investiert werden könnte. Wir von dentisratio haben es uns zur Aufgabe gemacht, zahnärztliche Praxen und Kliniken zu entlasten und Verwaltungsaufgaben im Praxisalltag zu reduzieren. Soll es in Ihrer Praxis mehr Zeit für Patienten geben? Wir übernehmen bundesweit Ihr Honorarmanagement, kümmern uns um die Verwaltung und stehen Ihnen mit betriebswirtschaftlicher Expertise zur Seite.

Role Description This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm CST. It may be necessary, given the business need, to work occasional overtime. We offer weeks of on-the-job training. The hours of the training will be during normal business hours. Primary Responsibilities: - Ensuring that coding and up front claim edits are resolved timely so claims can generate. - Accurately billing all patient claims to their specific insurance companies. - Conducting appropriate account follow-up on unpaid, underpaid or overpaid balances. - Working all associated correspondence received. - Working collaboratively with patients and their insurance companies to secure payment due. - Understanding place of service codes for professional billing. - Understanding general medical terminology. - Demonstrates understanding of various denials including but not limited to medical necessity, experimental, drugs, and laboratory. - Demonstrates how to effectively appeal / overturn denials resulting in accurate reimbursement. - Possesses knowledge of payer policies and guidelines to successfully overturn denials. - Proactively contacts insurance companies on past due balances and utilizes critical thinking skills to determine the most expedient way to get claims paid; this could also include contacting provider representatives or contact specialists. - Identifies and brings forth to management, any denial trends related to procedures, coding, and physicians. - Obtains supporting documentation necessary to resolve insurance company denials and submits information to the insurance company using appropriate appeal forms. - Monitor all assigned edit work lists, performing appropriate steps necessary to resolve all accounts in a timely manner; this includes timely responses for medical records requests, completion of additional information requests, etc., as requested by insurance companies. - Demonstrates excellent communication skills either verbally or written, by promptly and professionally answering or responding to phone calls, voicemail, or email. - Demonstrates effective personal time utilization, which includes appropriate levels of non-business-related talking, personal phone calls, breaks, lunch, tardiness and absenteeism. - Other duties as assigned. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Qualifications - High School Diploma / GED - Must be 18 years of age OR older - 3+ years of physician billing experience - Working knowledge of the claim denial process, including the Health Insurance Claim Form (HCFA) - Ability to navigate multiple programs and learn new and complex computer system applications - Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm CST. It may be necessary, given the business need, to work occasional overtime Preferred Qualifications - Ability to understand adjudication process in determining how a claim has been paid - Ability to work necessary claim edits prior to the claims going out to the payers, for accuracy, coding, registration, and/or payer guidelines Telecommuting Requirements - Ability to keep all company sensitive documents secure (if applicable) - Required to have a dedicated work area established that is separated from other living areas and provides information privacy. - Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service. Soft Skills - Ability to multi-task and to understand multiple products and multiple levels of benefits within each product - Ability to work autonomously Pay and Benefits Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as: - A comprehensive benefits package - Incentive and recognition programs - Equity stock purchase - 401k contribution (all benefits are subject to eligibility requirements) The hourly pay for this role will range from $20.38 - $36.44 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. Company Description At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Title: PandC Services Specialist with German (Services for Germany) Location: Poznan PL Job Description: Who you are you have Personnel Administration and Payroll experience, and you feel confident in this field, you know how to work with a ticket system, you know a thing or two about the labour law of Germany, you are no stranger to the SAP HR system, you are fluent in German and English you are comfortable using MS Office tools, you are looking for an employer who guarantees a sense of security, stability, diversity and openness to others, caring for the planet and doing things with people in mind are important for you, you are authentic in interactions with others and want to be able to pursue your passions, you enjoy taking the initiative and you do not shy away from a challenge. A day in your life with us Team Leader's morning briefing/catch-up with the team, processing of ongoing orders from the country, e.g. a request for a change to an Co-worker's employment terms in the systems, contact with the national P&C unit, e.g. clarification of an error in an insurance application, further processing in the system, FIKA, that is a coffee break (virtual or on the office patio), weekly team meeting, e.g. to discuss current topics, holiday plans, important instructions from the Business Partner, work in Excel, e.g. extracting a report from the system, conversation with your Buddy (your mentor during the onboarding), e.g. sharing the next bit of knowledge about a given process, lunch (if in the office, then with the team), self-study, e.g. e-learning concerning cultural differences or Excel carried out via a training platform, work at a "helpline", i.e. employee support line (telephone/e-mail/chat), reviewing company news, e.g. finding out who won the competition for the best photo promoting a healthy lifestyle. - The duties in a given position vary depending on the character of the team and the cyclical nature of the services delivered. How you feel in your workplace is important to us, so if you want your day at work to look similar to what is described above, feel free to apply. Together as a team In the P&C Germany team, together with Junior Specialists, Specialists and other Senior Specialists, you will process P&C and payroll matters for the employees of IKEA stores and companies in Germany. This includes answering colleagues' questions related to HR Administration and Payroll (via email and phone) or handling their personal data. You will be supported in your daily work by a Team Leader, whom you can consult in demanding situations. We're looking forward to meeting you! A little about us As Ingka Business Service Center, we are part of IKEA and we support stores and other IKEA units with financial and payroll services. Our office (Regional HUB Europe) is located in Poznań, at 6a Szwedzka Street (Centrum Franowo). We will provide you with the opportunity to spread your wings in the People&Culture field. What matters to us is whether our values, such as a sense of community, simplicity or renew and improve, appeal to you. With us, you can be yourself and work the way you want - we care about your authenticity and freedom of self-expression. We focus on job stability and building long-term relationships with our Co-workers (also through a loyalty program - working with us longer earns you an additional financial bonus). At IKEA, you manage your career - it is up to you to choose the path of development within the team, by taking part in international projects or even within the organisation worldwide. When you get to know us better, you will see that work at IKEA means… so much more! Our FIKA will perk you up for sure, but we offer more perks than that: hybrid working model, fantastic office furnished with IKEA furniture, divided into zones for work and relaxation and creative collaboration, free underground parking with electric charger and bicycle parking, stable employment (employment contract), flexible terms of employment (depending on the team - full-time and part-time), flexible working hours (we start work between 7 and 10 a.m.), annual appreciation bonus dependent on performance in the relevant fiscal year, home work allowance, cafeteria system - a pool of benefits to choose from (e.g. Multisport card, cinema tickets, shopping vouchers, medical package for relatives), Tack! loyalty programme for Co-workers - working with us longer earns you an additional financial bonus, private medical care for IKEA Co-workers and their families, wellbeing support - Edenred pre-paid lunch card, Employee Assistance Programme - support in difficult life situations, personal accident insurance and pension plan, jubilee awards, gifts and special events, additional 4-week paternity leave, cofinancing of language courses.