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Prior Authorization Associate Jobs in California

Ardelyx

Field Reimbursement Manager - Boston

Fremont, CA · On-site

$145K - $190K/yr

Aid HCPs with supporting the patient journey by providing education on prior authorization, appeals ... This position reports to an Associate Director/Director, Field Access and Reimbursement * Travel ...

Oso Home Care

Reimbursement Specialist

Irvine, CA · On-site

$25 - $31/hr

Associate degree in Medical Billing, Healthcare Administration, or related field preferred ... and prior authorization requirements. * Knowledge of medical terminology and infusion pharmacy ...

Oso Home Care

Reimbursement Specialist

Irvine, CA · On-site

$25 - $31/hr

Associate degree in Medical Billing, Healthcare Administration, or related field preferred ... and prior authorization requirements. * Knowledge of medical terminology and infusion pharmacy ...

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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

Field Reimbursement Manager - Boston

Ardelyx

Fremont, CA • On-site

$145K - $190K/yr

Other

Medical, Dental, Vision, Life, Retirement

Re-posted 21 hours ago

Job description

Description
Ardelyx is a commercial-stage biopharmaceutical company focused on redefining treatment approaches for patients with significant unmet medical needs. By combining scientific innovation with a collaborative, purpose-driven culture, we strive to create meaningful impact for patients.
Team Ardelyx is united by a shared mission and guided by our core values: Passionate, Fearless, Dedicated, and Inclusive.
We foster an inclusive environment where employees are respected, supported, and empowered to make an impact - both within our company and in the lives of patients we serve.
Position Summary:
The Field Reimbursement Manager (FRM) is responsible for supporting the patient access process for our gastroenterology business. The FRM will leverage his/her account management, data analytics, and reimbursement expertise and demonstrated experience to support and facilitate timely access to Ardelyx's products! This role involves supporting products by executing the collaborative territory strategic plan, understanding the patient access process, and navigating patient support programs. The FRMs will collaborate with key team members such as Field Sales and other internal stakeholders to serve as access and reimbursement experts for assigned geographies. If you'd like to help establish Ardelyx as a leading company in the biopharma industry, one that advances patient care with novel therapies that meet important clinical needs, come join us!
Responsibilities:
  • Establish and maintain collaborative working relationships with Patient Services Program Partners, Field Sales, and Healthcare Providers to support patient access
  • Aid HCPs with supporting the patient journey by providing education on prior authorization, appeals, and/or denials
  • Review patient-specific information in cases where the site has specifically requested assistance resolving any issues or coverage challenges when appropriate
  • Partner with internal and external stakeholders to identify, anticipate and address patient and HCP access barriers; Implement updates/changes based on solutions generated to address barriers
  • Utilize HUB and specialty pharmacy partners to ensure patient access barriers are removed
  • Monitor patients start trends in assigned geographies/plans, and collaborate with Field Sales and Patient Services partners to proactively address and mitigate challenges
  • Maintain knowledge of national, regional, local, and account market dynamics for payors and prescribers; maintain knowledge of HUB and specialty distribution channels to support patient needs
  • Serve as subject matter expert regarding education and insights on access and affordability solutions across multiple payer types and plans (i.e., Medicare, Medicaid Managed Care, Commercial)
  • Understands and adapts to the changing healthcare ecosystem to customize resourcing and messaging to HCPs and HCP staff
Qualifications:
  • B.A/B.S. degree with 6 - 9 years of experience in field reimbursement, patient services, market access, or related functions within the pharmaceutical/biotech industry or equivalent experience
  • 3 - 5 years of experience as a field reimbursement manager within public or private field reimbursement or access services, healthcare operations, and/or equivalent experience
  • Extensive knowledge of medication access channels preferred
  • Strong functional knowledge of specialty pharmacy and health insurance and benefits (i.e. Medicare Part D, commercial and Medicaid) with a demonstrated expert understanding of insurance eligibility, benefit verification, prior authorization processes, reimbursement coverage, appealing insurance denials, application of financial assistance, co-pay support and free product programs
  • Knowledge of HCP office processes regarding patient flow, prescription flow and clinic office operations. Direct experience with GI products or providers preferred
  • Outstanding customer relationship, interpersonal, and communication skills with the established ability to effectively work with diverse audiences and influence cross-functionally
  • Ability to evaluate data and identify trends, barriers, and translate into actionable steps
Work Environment:
  • This position reports to an Associate Director/Director, Field Access and Reimbursement
  • Travel will vary by territory and business need
  • Up to 75% of time spent in the field required
The anticipated annualized base pay range for this full-time position is $145,000-$190,000. Ardelyx utilizes industry data to ensure that our compensation is competitive and aligned with our industry peers. Actual base pay will be determined based on a variety of factors, including years of relevant experience, training, qualifications, and internal equity. The compensation package may also include an annual bonus target and equity awards, subject to eligibility and other requirements.
Ardelyx also offers a robust benefits package to employees, including a 401(k) plan with generous employer match, 12 weeks of paid parental leave, up to 12 weeks living organ and bone marrow leave, equity incentive plans, health plans (medical, prescription drug, dental, and vision), life insurance and disability, flexible time off, annual Winter Holiday shut down, and at least 11 paid holidays.
Ardelyx is an equal opportunity employer.
We do not accept unsolicited resumes from search firms, or recruiters or similar vendors. Any such unsolicited resume submitted to any employee or through Company's career site without a valid, signed search agreement signed by Company's authorized representative will be deemed the property of the company, and no fees will be paid in the event of a hire. Company will have the right to hire any such candidate at its discretion without any financial obligation or fee owed to the vendor. Any verbal or written communication with a Company employee outside of this process will not be considered a binding agreement.

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