Manager Prior Authorization Rn Jobs (NOW HIRING)

We are seeking a detail-oriented and proactive Prior Authorization (Buy and Bill) Specialist to join our clinic team. In this role, you will handle scheduling, inventory management, and authorization processes, while collaborating on innovative tech solutions and supporting site expansions along the Prior Authorization Manager and/or Practice Manager. This position requires strong organizational skills, knowledge of healthcare billing practices (Buy & Bill), and the ability to work in a fast-paced medical environment.

This is a full-time, non-exempt (hourly) position, scheduled for 40 hours per week. Work hours may vary based on assigned clinic location, Monday through Friday.

This role will be based primarily in our Sorrento Valley clinic but may also provide support to other nearby locations within San Diego County. The ideal candidate is adaptable and enjoys collaborating across multiple sites to ensure seamless operations and excellent patient experiences.

• Call insurance companies to verify coverage (PPO and HMO), obtain benefit details, and confirm authorization requirements.
• Submit, track, and manage prior authorizations in a timely manner, ensuring documentation meets payer and clinical requirements.
• Coordinate with clinics and Practice Managers to align on injection and medication timelines, patient scheduling, and clinical administration.
• Schedule appointments and times for patients to receive their medications, coordinating with clinical staff to ensure timely and appropriate administration.
• Track medication inventory levels, monitor stock to prevent shortages, and initiate purchasing orders as needed to maintain adequate supplies.
• Monitor reimbursement and billing success rates, analyze denials or discrepancies, and collaborate with billing teams to resolve issues and improve collection processes.
• Implement checks to prevent patients from receiving medications too early, adhering to prescribed intervals and regulatory guidelines.
• Verify that all necessary authorizations are in place prior to medication administration, minimizing risks of non-reimbursement or compliance violations.

• Calling payers, submitting new and renewal prior authorizations, and following up to ensure timely approvals.
• Updating patient notes and EHR records to reflect authorization status and next steps.
• Coordinating with clinics and patients to manage scheduling, follow-ups, and re-authorizations.
• Communicating with pharmacies to confirm shipments and ensure medications are delivered on time.
• Monitoring injection timelines to prevent care delays and authorization lapses.

• Education: Bachelor's degree in healthcare administration, business, or related field preferred
• Experience:  
  • 2+ years of experience in healthcare administration, medical billing, or inventory management, with familiarity in buy-and-bill processes for medications.
  • Relevant certifications (e.g., Certified Medical Assistant or Billing Specialist) preferred.
  • Medical or medical assistant background strongly preferred.
  • Strong understanding of insurance prior authorizations, reimbursement policies, and healthcare compliance regulations (e.g., HIPAA, Medicare/Medicaid guidelines).
  • Proficiency in medical software systems, inventory management tools, and Microsoft Office Suite; experience with automation or tech integration projects is a plus
• Skills & Abilities:
  • Excellent organizational and multitasking skills, with the ability to prioritize tasks in a dynamic environment.
  • Strong communication and negotiation abilities for working with vendors, tech partners, insurers, and internal teams.
  • Attention to detail and problem-solving mindset to handle complex billing and authorization scenarios.
  • Ability to work independently and collaboratively in a team-oriented settings.

The hourly range for this position is $22.00-30.00/hour. The actual compensation for this role will be determined by a variety of factors, including but not limited to the candidate's skills, education, and experience.