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Prior Authorization Coordinator Jobs in Riverside, CA

Oso Home Care

Authorization Specialist

Irvine, CA · On-site

$23 - $25.90/hr

This position works closely with Intake Coordinators, Benefits Verification Specialists ... Submit prior authorization requests to commercial insurance carriers, Medicare Advantage plans ...

Oso Home Care

Authorization Specialist

Irvine, CA · On-site

$23 - $25.90/hr

This position works closely with Intake Coordinators, Benefits Verification Specialists ... Submit prior authorization requests to commercial insurance carriers, Medicare Advantage plans ...

Oso Home Care

Intake Coordinator - Full-Time

Irvine, CA · On-site

$26 - $33/hr

Authorization Coordination * Determine prior authorization requirements based on payer guidelines and prescribed therapy. * Coordinate authorization requests with the Authorization Specialist and ...

Oso Home Care

Intake Coordinator - Full-Time

Irvine, CA · On-site

$26 - $33/hr

Authorization Coordination * Determine prior authorization requirements based on payer guidelines and prescribed therapy. * Coordinate authorization requests with the Authorization Specialist and ...

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All JobsPrior Authorization JobsPrior Authorization Coordinator JobsPrior Authorization Coordinator Jobs in Riverside, CA

Prior Authorization Coordinator information

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How much do prior authorization coordinator jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for prior authorization coordinator in Riverside, CA is $22.24, according to ZipRecruiter salary data. Most workers in this role earn between $18.56 and $23.08 per hour, depending on experience, location, and employer.

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

AspectPrior Authorization CoordinatorMedical Billing Specialist
CredentialsTypically requires knowledge of insurance policies, healthcare regulations, and sometimes certifications like CPC or CPC-HRequires coding certifications (CPC, CCS) and knowledge of billing procedures
Work EnvironmentHealthcare facilities, insurance companies, or billing companiesMedical offices, hospitals, or billing companies
Employer & Industry UsageUsed in healthcare settings to manage insurance approvalsUsed across healthcare to process and submit claims
Search & Comparison IntentPeople compare roles related to insurance approval processesPeople compare roles related to billing and claims processing

The Prior Authorization Coordinator focuses on obtaining insurance approvals before treatment, ensuring coverage compliance. In contrast, the Medical Billing Specialist handles submitting claims and processing payments after services are rendered. Both roles are essential in healthcare administration but differ in their primary functions and workflows.

What are the key skills and qualifications needed to thrive as a prior authorization coordinator?

To thrive as a Prior Authorization Coordinator, you need strong knowledge of medical terminology, insurance processes, and healthcare regulations, often supported by experience in medical billing or a related certification. Familiarity with electronic health records (EHR), insurance portals, and prior authorization management systems is typically required. Attention to detail, organizational skills, and effective communication are essential soft skills for efficiently handling authorization requests and collaborating with providers and insurers. These skills ensure timely approvals, minimize claim denials, and support smooth patient access to prescribed care.

What is a prior authorization coordinator?

Prior Authorization Coordinators are healthcare professionals responsible for managing and obtaining approval from insurance companies before certain medical services, procedures, or medications are provided to patients. Their main duties include reviewing patient information, communicating with healthcare providers and insurers, and ensuring all necessary documentation is submitted for timely authorization. They play a crucial role in reducing delays in care and helping patients navigate complex insurance requirements. Strong communication, attention to detail, and knowledge of insurance processes are essential skills for this role.

What are some common challenges faced by prior authorization coordinators, and how can they be managed effectively?

Prior Authorization Coordinators often encounter challenges such as navigating complex insurance requirements, keeping up with frequent policy changes, and managing high volumes of requests. To handle these effectively, coordinators need strong organizational skills, attention to detail, and the ability to communicate clearly with both healthcare providers and insurance representatives. Staying updated on payer guidelines and using electronic health record (EHR) systems efficiently can also streamline the process and reduce delays in patient care.
What are the most commonly searched types of Prior Authorization jobs in Riverside, CA? The most popular types of Prior Authorization jobs in Riverside, CA are:
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Prior Authorization Coordinator jobs near you
Infographic showing various Prior Authorization Coordinator job openings in Riverside, CA as of August 2026, with employment types broken down into 93% Full Time, and 7% Contract. Highlights an 100% In-person job distribution, with an average salary of $46,257 per year, or $22.2 per hour.

Prior Authorization LVN

LSMA Management Inc

San Bernardino, CA

$35 - $40/hr

Full-time

Posted 19 days ago

Job description

Description

JOB SUMMARY:

The Prior Authorization Nurse (LVN) is responsible for performing clinical review and evaluation of authorization requests to ensure medical necessity, appropriate utilization of healthcare services, and compliance with regulatory and health plan requirements. This role conducts prospective, concurrent, and retrospective review of medical services including specialty care, diagnostic procedures, elective admissions, post-acute services, and out-of-network referrals. The Prior Authorization LVN collaborates with providers, health plans, and internal clinical teams to support timely care coordination while ensuring adherence to CMS, NCQA, and organizational guidelines. The position serves as a clinical resource to Prior Authorization Coordinators and supports efficient utilization management operations.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS:


Education/Training

Minimum: High School diploma or equivalent required. Graduate from an accredited Vocational Nursing Program.  


Experience

Minimum: At least one year of clinical experience in a healthcare setting. Basic knowledge of medical terminology, utilization management processes, and clinical care practices.

Preferred: Two or more years of utilization management, prior authorization, case management, or managed care experience. Experience working in an MSO, IPA, health plan, or medical group environment. Experience using Milliman Care Guidelines (MCG), InterQual, or similar criteria tools. Knowledge of ICD-10, CPT, and HCPCS coding. Experience with electronic health record and utilization management systems.

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


Certification(s)

Current, active, unrestricted California LVN license required.

Skills, Knowledge & Abilities

Knowledge of utilization management principles, medical necessity criteria, and managed care processes.

Understanding of clinical documentation and healthcare delivery systems.

Familiarity with regulatory requirements including NCQA, CMS, and HIPAA.

Strong verbal and written communication skills.

Ability to effectively communicate with physicians, providers, and interdisciplinary teams.

Ability to provide clear and professional clinical guidance.

Ability to review and interpret clinical information and apply established criteria.

Strong organizational and prioritization skills.

Ability to manage multiple tasks and deadlines efficiently.

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

Ability to use electronic medical records and authorization systems.

Ability to learn and adapt to new software and technology.

Strong attention to detail and accuracy.

Ability to maintain confidentiality and professionalism.

Ability to work independently and as part of a team.   

Ability to review and interpret clinical information and apply established criteria.

Strong organizational and prioritization skills.

Ability to manage multiple tasks and deadlines efficiently.

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

Ability to use electronic medical records and authorization systems.

Ability to learn and adapt to new software and technology.

Strong attention to detail and accuracy.

Ability to maintain confidentiality and professionalism.

Ability to work independently and as part of a team.


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 work. Occasional standing, walking, bending, and reaching. Ability to lift up to 20 pounds occasionally. Ability to concentrate for extended periods while reviewing clinical documentation. Ability to manage multiple priorities in a fast-paced environment. Ability to exercise sound clinical judgment and decision-making. Frequent interaction with healthcare providers and internal staff via phone and electronic communication. Low to moderate noise level consistent with office environment.


 PAY RANGE 

$35.00 - $40.00 / hourly

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