Prior Authorization Associate Jobs in California

Oso Home Care is seeking an experienced, detail-oriented, and compassionate Intake Coordinator to join our Specialty Home Infusion Pharmacy team in Burbank. Since 1984, Oso Home Care has been a leader in specialty home infusion pharmacy, ambulatory infusion center (AIC), and home health services throughout Southern California.

The Intake Coordinator serves as the primary point of contact for new patient referrals and is responsible for coordinating the intake process from referral receipt through admission to service. This position works closely with physicians, hospitals, case managers, referral sources, insurance companies, pharmacists, nurses, and internal departments to ensure patients receive timely access to infusion therapy.

The ideal candidate possesses strong knowledge of home infusion services, insurance verification, prior authorization requirements, medical terminology, and payer guidelines while providing exceptional customer service to patients, families, and referral sources.

• Receive and process referrals for specialty home infusion pharmacy services from physician offices, hospitals, infusion centers, case managers, skilled nursing facilities, and other referral sources.
• Review referrals for completeness and identify missing clinical or demographic information.
• Conduct initial patient intake by gathering demographic, clinical, insurance, and physician information.
• Enter patient demographics, diagnoses, insurance information, physician orders, and referral documentation into the electronic medical record.
• Prioritize referrals based on clinical urgency and prescribed therapy.

• Verify insurance eligibility and benefits for Medicare, Medi-Cal, Managed Medi-Cal, Medicare Advantage, PPO, HMO, IPA, and commercial insurance plans.
• Review deductibles, co-payments, coinsurance, out-of-pocket maximums, and coverage limitations.
• Identify payer-specific requirements for specialty infusion therapies.
• Coordinate prior authorization requests with physician offices and insurance companies.
• Track authorization status and communicate updates to appropriate clinical staff.
• Ensure all required authorizations are obtained before therapy is initiated.

• Obtain physician orders, progress notes, history and physicals, laboratory results, medication lists, infusion orders, and other supporting clinical documentation.
• Review documentation for completeness prior to pharmacist review.
• Coordinate with physician offices to obtain missing information needed for clinical review and insurance approval.
• Ensure documentation supports payer requirements and medical necessity.

• Collaborate with pharmacists regarding new patient referrals and clinical review requirements.
• Coordinate medication start dates, delivery schedules, and patient admissions.
• Communicate referral status and authorization updates to the pharmacy team.
• Assist in ensuring all required documentation is available prior to medication preparation and dispensing.

• Serve as a primary point of contact for patients, caregivers, physicians, hospitals, case managers, and referral sources throughout the intake process.
• Explain insurance coverage, authorization requirements, and estimated patient financial responsibility.
• Provide timely updates regarding referral status and anticipated start of care.
• Deliver exceptional customer service while maintaining professionalism and compassion.

• Coordinate medication deliveries, nursing visits, and infusion appointments with Pharmacy, Nursing, and Delivery departments.
• Ensure timely communication regarding changes in patient schedules or therapy start dates.
• Assist with hospital discharges and transitions of care to prevent delays in treatment.

• Maintain complete, accurate, and timely documentation within the electronic medical record.
• Document referral activity, insurance verification, authorization status, physician communications, and patient interactions.
• Ensure patient records comply with company policies, payer requirements, and accreditation standards.

Maintain compliance with:

• HIPAA Privacy and Security Rules
• CMS regulations
• Medicare and Medi-Cal requirements
• ACHC Accreditation Standards
• California Board of Pharmacy regulations
• Company policies and procedures

Maintain strict confidentiality of all patient information.

• Participate in departmental meetings, quality improvement initiatives, and ongoing training.
• Identify opportunities to improve referral processing and workflow efficiency.
• Support accreditation surveys, internal audits, and performance improvement activities.

• High School Diploma or equivalent required.
• Associate's or Bachelor's degree in Healthcare Administration, Medical Assisting, Business Administration, or related field preferred.
• Minimum 2 years of experience in healthcare intake, home infusion, specialty pharmacy, home health, hospital admissions, or referral coordination.
• Experience with insurance verification and prior authorization processes required.
• Previous experience in home infusion or specialty pharmacy strongly preferred.

• Knowledge of medical terminology.
• Working knowledge of:
  • HCPCS Codes
  • ICD-10 Diagnosis Codes
  • CPT Codes
  • Insurance verification
  • Prior authorization processes
  • Medicare
  • Medi-Cal
  • Commercial insurance plans
  • Specialty infusion therapies
• Familiarity with electronic medical records (EMR) and pharmacy management systems.
• Proficiency in Microsoft Office Suite, including Word, Excel, and Outlook.
• Strong organizational, multitasking, and problem-solving skills.
• Excellent written and verbal communication skills.
• Ability to manage multiple referrals while meeting established turnaround times.
• Strong customer service and interpersonal skills.

• Patient-Centered Service
• Customer Service Excellence
• Communication
• Attention to Detail
• Organization
• Time Management
• Critical Thinking
• Teamwork
• Accountability
• Adaptability
• Regulatory Compliance
• Problem Solving

The Intake Coordinator is expected to:

• Process referrals accurately and efficiently within departmental turnaround standards.
• Complete insurance verification and coordinate prior authorizations in a timely manner.
• Maintain complete and accurate patient documentation.
• Communicate effectively with patients, referral sources, physicians, and internal departments.
• Support timely initiation of infusion therapy.
• Maintain compliance with all payer, regulatory, accreditation, and company requirements.
• Contribute to departmental quality improvement and patient satisfaction initiatives.

Founded in 1984, Oso Home Care is a privately owned leader in specialty home infusion pharmacy, ambulatory infusion services, and home health care throughout Southern California. We are committed to delivering exceptional patient care through clinical excellence, innovation, compassion, and teamwork.

At Oso Home Care, you'll become part of a collaborative, family-oriented organization that values integrity, accountability, and professional growth. Our employees play an essential role in helping patients receive life-changing therapies safely and efficiently while making a meaningful difference in their lives every day.

Oso Home Care is proud to be an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other status protected by applicable federal, state, or local law.