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Prior Authorization Associate Jobs in California

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 ...

Robert Half

UM Coordinator

Long Beach, CA · On-site

$23 - $27/hr

High school diploma or equivalent required; an associate degree is preferred. * At least 1 year of experience in healthcare administration, medical office support, prior authorization, or managed ...

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Prior Authorization Associate information

What is a prior authorization associate?

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 the key skills and qualifications needed to thrive as a prior authorization associate?

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 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.

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.

Is a prior authorization associate a stressful job?

A prior authorization associate's job can be stressful due to the need for accuracy, meeting deadlines, and managing complex insurance requirements. The role often involves handling high volumes of requests and communicating with healthcare providers and insurers, which can contribute to workplace pressure.

What are the most commonly searched types of Prior Authorization jobs in California?

The most popular types of Prior Authorization jobs in California are:

What are popular job titles related to Prior Authorization Associate jobs in California?

For Prior Authorization Associate jobs in California, the most frequently searched job titles are:

What job categories do people searching Prior Authorization Associate jobs in California look for?

The top searched job categories for Prior Authorization Associate jobs in California are:

What cities in California are hiring for Prior Authorization Associate jobs?

Cities in California with the most Prior Authorization Associate job openings:

Prior Authorization Associate jobs near you

Prior Authorization Coordinator

LSMA Management Inc

San Bernardino, CA • On-site

$26 - $29/hr

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Description

JOB SUMMARY

The Prior Authorization Coordinator is responsible for supporting the Utilization Management department by facilitating the administrative components of the prior authorization process. This role ensures accurate data entry, eligibility verification, documentation management, and coordination between providers, health plans, and clinical staff. The Coordinator prepares authorization requests for clinical review, ensures completeness of documentation, and assists in maintaining compliance with regulatory, health plan, and organizational requirements. This position plays a critical role in supporting timely and accurate authorization processing to promote continuity of care and efficient utilization of healthcare services within a Managed Services Organization (MSO).

Requirements

MINIMUM & PREFERRED QUALIFICATIONS


Education/Training

Minimum: High School diploma or equivalent required.

Preferred: Medical Assistant diploma or Associate's degree in healthcare administration, business administration, or related field preferred.


Experience

Minimum: At least one year of administrative experience in a healthcare, medical office, MSO, IPA, or health plan environment. Basic knowledge of medical office procedures and managed care processes.

Preferred: Experience working in Utilization Management, Prior Authorization, Referral Management, or Medical Management within an MSO, IPA, medical group, or health plan. Knowledge of medical terminology. Experience with electronic medical records, utilization management systems, or authorization platforms. Familiarity with CPT, ICD-10, and HCPCS codes preferred. Experience supporting Medi-Cal, Medicare, or commercial managed care plans preferred.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Skills, Knowledge & Abilities

Strong data entry skills with attention to detail and accuracy.

Ability to manage multiple tasks and prioritize workload efficiently.

Proficiency in Microsoft Office applications (Word, Excel, Outlook).

Ability to learn and use electronic medical record and authorization systems.

Strong verbal and written communication skills.

Ability to communicate professionally with providers, health plans, and internal staff.

Strong customer service skills with a service-oriented approach.

Ability to review documentation for completeness and accuracy.

Strong organizational and time management skills.

Ability to work in a fast-paced, deadline-driven environment.

Ability to maintain confidentiality and protect sensitive health information.

Ability to work independently and collaboratively as part of a team.

Strong attention to detail and commitment to quality. 

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical demands described here are represented of those that must be met by an employee to successfully perform the essential functions of this job. Prolonged sitting, typing, and computer use. Occasional standing, walking, bending, and reaching. Ability to lift up to 20 pounds occasionally. Ability to concentrate and review detailed information for extended periods. Ability to manage multiple priorities and meet deadlines. Ability to perform repetitive tasks with a high degree of accuracy. Office-based work environment within an MSO or medical management setting. Frequent interaction with internal staff, providers, and health plans via phone and electronic communication. Low to moderate noise level typical of an office environment.


PAY RANGE

$26.00 - $29.00 / hourly

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