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Prior Authorization Associate Jobs in California

Adecco

Authorization Coordinator

Menlo Park, CA · Remote

$28/hr

Strong knowledge of insurance verification and prior authorization processes. * Excellent ... In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other ...

Advanced Medical Management

UM Coordinator

Long Beach, CA · On-site

$23 - $27/hr

Associate degree preferred Experience * Minimum 1 year in healthcare * Prior authorization experience preferred * Managed care experience preferred * Medical office experience preferred * Health plan ...

Advanced Medical Management

UM Coordinator

Long Beach, CA · On-site

$23 - $27/hr

Associate degree preferred Experience * Minimum 1 year in healthcare * Prior authorization experience preferred * Managed care experience preferred * Medical office experience preferred * Health plan ...

Elevance Health

Pharmacy Technician II

Garden Grove, CA · On-site

$22.16 - $33.24/hr

Processes prior authorization requests from physicians' offices and ensures compliance with ... Associates in this role are expected to have strong oral, written and interpersonal communication ...

Elevance Health

Pharmacy Technician II

Garden Grove, CA · On-site

$22.16 - $33.24/hr

Processes prior authorization requests from physicians' offices and ensures compliance with ... Associates in this role are expected to have strong oral, written and interpersonal communication ...

Oso Home Care

Intake Coordinator - Full-Time

Irvine, CA · On-site

$26 - $33/hr

Verify insurance coverage and obtain prior authorizations as needed. * Schedule and coordinate home ... Qualifications: * High school diploma or equivalent; associate or bachelor's degree preferred.

Oso Home Care

Intake Coordinator - Full-Time

Irvine, CA · On-site

$26 - $33/hr

Verify insurance coverage and obtain prior authorizations as needed. * Schedule and coordinate home ... Qualifications: * High school diploma or equivalent; associate or bachelor's degree preferred.

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Prior Authorization Associate information

What is the difference between Prior Authorization Associate vs Medical Billing Specialist?

AspectPrior Authorization AssociateMedical Billing Specialist
CredentialsHigh school diploma or equivalent; certification in medical billing or coding often preferredHigh school diploma or equivalent; certification in medical billing or coding often preferred
Work EnvironmentHealthcare offices, insurance companies, hospitalsHealthcare offices, billing companies, hospitals
Primary ResponsibilitiesObtain prior authorizations from insurance for procedures and treatmentsProcess and submit medical claims, handle billing and payments

The main difference is that a Prior Authorization Associate focuses on securing insurance approvals before procedures, while a Medical Billing Specialist manages the billing process after services are rendered. Both roles require similar credentials and often work in healthcare settings, but their core functions differ in the patient care and revenue cycle process.

What are the key skills and qualifications needed to thrive as a Prior Authorization Associate, and why are they important?

To thrive as a Prior Authorization Associate, you need a strong understanding of medical terminology, insurance processes, and prior authorization requirements, often backed by a high school diploma or associate degree. Familiarity with healthcare management software, electronic health record (EHR) systems, and payer portals is typically required. Excellent attention to detail, organizational skills, and effective communication are essential soft skills for this role. These skills ensure timely and accurate processing of prior authorizations, minimizing delays in patient care and supporting efficient healthcare operations.

What are Prior Authorization Associates?

Prior Authorization Associates are professionals who handle the process of obtaining approval from insurance companies before certain medical services, procedures, or medications are provided to patients. They review clinical documentation, communicate with healthcare providers and insurers, and ensure all necessary information is submitted for timely authorization. Their work helps reduce claim denials and ensures patients receive the care they need while adhering to insurance requirements.

What are some common challenges faced by a Prior Authorization Associate, and how can they be effectively managed?

Prior Authorization Associates often encounter challenges such as navigating complex insurance requirements, handling high volumes of authorization requests, and managing tight turnaround times. Staying organized, keeping up-to-date with payer policies, and using robust tracking systems can help manage these difficulties. Collaborating closely with clinical staff and insurance representatives is also essential for resolving issues quickly and ensuring approvals are processed efficiently. Developing strong communication and problem-solving skills is key to success in this role.
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Prior Authorization Associate jobs near you
Senior Central Prior Authorization Analyst

Senior Central Prior Authorization Analyst

Adventist Health

Roseville, CA • On-site, Remote

$30.91 - $40.33/hr

Full-time

Posted 27 days ago

Job description


Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Serves as a subject matter expert and strategic partner in optimizing infusion site-of-care decisions, pharmacy access, and revenue integrity. This role operates with a high degree of autonomy and is responsible not only for executing complex workflows, but also for leading process improvement initiatives, influencing cross-functional stakeholders, and driving measurable financial and operational outcomes. In coordination with financial clearance, pharmacy, and clinical teams, this role evaluates and determines the most appropriate infusion site of care based on clinical appropriateness, payer policy, and financial impact. The Senior Analyst leverages advanced analytics, deep payer knowledge, and system-wide insights to optimize patient access, minimize denials, and maximize reimbursement across the continuum of care.
Job Requirements:
Education and Work Experience:
  • High School Education/GED or equivalent: Preferred
  • Associate's/Technical Degree or equivalent combination of education/related experience: Preferred
  • Six years' of progressive experience in infusion, specialty pharmacy, revenue cycle, or related healthcare operations: Required
  • Experience in Epic or similar electronic medical records (EMR) platforms: Preferred
  • Knowledge of healthcare insurance, prior authorization and/or coding: Preferred

Licenses/Certifications:
  • State Pharmacy Technician license (CA, OR, &/or HI): Preferred
  • Pharmaceutical Technician Board certification: Preferred
  • Advanced certification (e.g., CHRI, CRCR, or 340B ACE): Preferred
  • Pharmaceutical Technician Board certification: Preferred

Essential Functions:
  • Serves as the lead subject matter expert for infusion site-of-care strategy, payer requirements, and pharmacy benefit optimization. Independently evaluate complex patient cases to determine optimal infusion site of care, balancing clinical appropriateness, payer constraints, and financial impact. Lead coordination with central financial clearance, pharmacy operations, and clinical teams to ensure seamless referral routing across home infusion, ambulatory infusion, and alternate care sites.
  • Oversee and perform advanced benefit investigation, prior authorization strategy, and denials resolution, including escalation of high-risk or high-dollar cases. Identify trends in denials, payer behavior, and workflow inefficiencies; develop and implement data-driven process improvements. Act as a strategic liaison between pharmacy, revenue cycle, and clinical operations to enhance patient access and optimize reimbursement.
  • Provide guidance, training, and mentorship to analysts and technicians; serve as an escalation point for complex issues. Drive standardization of workflows, documentation practices, and referral processes across the health system. Promote and articulate the value of the infusion hub model and site-of-care strategy to internal and external stakeholders. Build and maintain strong relationships with physicians, clinic leadership, pharmacy teams, and payers.
  • Act as a financial advocate for patients, leveraging manufacturer assistance programs, foundations, and alternative funding sources. Participate in or lead cross-functional projects, pilots, and system implementations related to pharmacy services and revenue optimization. Ensure compliance with regulatory requirements (e.g., CMS, payer policies, 340B considerations where applicable).
  • Provide coverage support while maintaining oversight of broader program performance and service delivery. Assesses, develops, and recommends the best method of providing ambulatory infusion pharmacy services to support patients based on health system guidance. Develops and maintains close relationships with clinic staff, physician, pharmacy and other hospital contacts. Independently, and working hand in hand with client authorization resources, facilitates benefits verification and prior authorizations services for infusion site of care patients.
  • Performs other job-related duties as assigned.

Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
About Us
Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

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