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Prior Authorization Associate Jobs in California

Medix

Intake Coordinator

Irvine, CA · On-site

$26 - $30/hr

Submit clinical documentation for prior authorization approvals. * Communicate financial ... Associate degree or higher in a related field. Schedule / Shift M-F, 8am-5pm Benefits * Paid Sick ...

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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

Patient Care Navigator

COPE Health Solutions

Los Angeles, CA • On-site

Full-time

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

Job description

The Care Navigator is a team member who supports the Care at Home Solutions team with administrative duties and facilitates patient continuity of care.  Under the clinical direction and oversight of the Program Director and APP, the Care Navigator navigates patients at risk by collaborating with the patient, family, and members of the healthcare team to serve needs and expedite appropriate, cost-effective care. Working closely with the Medical Director, Advanced Practice Provider (APP), Registered Nurse (RN), Pharmacist, Community Health Workers (CHWs), and primary and specialty providers, the Patient Care Navigator helps patients navigate the healthcare system, access needed services and remain engaged in their care plans. This role supports Annual Wellness Visit (AWV) completion, chronic disease management, referral coordination, specialty access, and achievement of value-based care performance goals.

FLSA Status

Non-Exempt

Salary Range

$25.00-$29.00

Reports To

Administrator / Practice Manager

Direct Reports

None

Location

Hybrid; LA Office

Travel

Up to 30%

Work Type

Regular

Schedule

Full Time

 

Position Description:

  • Serves as a primary point of contact for patients, caregivers, and community partners.
  • Schedules telehealth and in-person appointments with physicians, APPs, pharmacists, specialists, and other care team members.
  • Conducts patient intake, registration, insurance verification, and demographic updates.
  • Coordinates referrals, specialty appointments, diagnostic testing, and follow-up services.
  • Assists with prior authorization requests and tracks authorization status.
  • Performs outreach to schedule Annual Wellness Visits (AWVs), preventive screenings, chronic care follow-up appointments, and quality gap closure initiatives.
  • Monitors appointment adherence and conducts outreach to reduce no-shows and missed visits.
  • Supports patient onboarding and education regarding telehealth technology and practice workflows.
  • Coordinates communication among providers, Community Health Workers, pharmacists, nurses, and external healthcare organizations.
  • Receives patient inquiries and escalates clinical concerns to licensed clinical staff in accordance with organizational protocols.
  • Supports care transitions following hospitalizations, emergency department visits, and specialty care encounters.
  • Maintains accurate and timely documentation within the Electronic Medical Record (EMR) and other designated systems.
  • Participates in interdisciplinary care team meetings and population health initiatives.
  • Supports achievement of organizational goals related to access, patient experience, quality performance, and value-based care outcomes.

Qualifications

  • High school diploma or equivalent required.
  • Associate degree or healthcare-related certification preferred.
  • Minimum two (2) years of experience in a medical office, physician practice, care coordination, scheduling, referral management, or healthcare customer service role preferred.
  • Experience supporting Medicare Advantage, managed care, primary care, or value-based care programs preferred.
  • Experience with referral management, prior authorizations, and appointment scheduling preferred.
  • Experience using Electronic Medical Record (EMR) systems required.
  • Bilingual English/Spanish preferred.

Working Knowledge of the Following Required

  • Medical office operations and patient scheduling workflows.
  • Medicare Advantage and commercial payer programs.
  • Referral management and prior authorization processes.
  • Customer service and patient engagement principles.
  • Telehealth care delivery models.
  • Electronic Medical Record (EMR) systems and healthcare technology platforms.

Examples of Competencies

  • Strong customer service and patient engagement skills.
  • Excellent organizational and follow-up abilities.
  • Ability to manage multiple priorities in a fast-paced healthcare environment.
  • Strong communication and interpersonal skills.
  • Attention to detail and documentation accuracy.
  • Ability to work collaboratively within interdisciplinary care teams.
  • Professionalism, accountability, and problem-solving capabilities.
  • Commitment to patient-centered service and operational excellence.

Benefits:

As a firm passionate about health care, we’re deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities, and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/why-cope-health-solutions/.  

About COPE Health Solutions
COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. For more information, visit CopeHealthSolutions.com.

 

To Apply:

To apply for this position, or to view all available positions, visit us at https://copehealthsolutions.com/careers/open-positions/.