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Prior Authorization Jobs in Modesto, CA (NOW HIRING)

Donor Network West

Family Resource Coordinator

Modesto, CA

$23.25 - $29.50/hr

Access donor registries to determine prior authorization for donation. * Communicates with the attending physician and other members of the healthcare team to establish rapport and ensure a ...

Donor Network West

Family Resource Coordinator

Modesto, CA · On-site

$23.25 - $29.50/hr

Access donor registries to determine prior authorization for donation. * Communicates with the attending physician and other members of the healthcare team to establish rapport and ensure a ...

Abbott

Medical Billing Specialist

Livermore, CA · On-site

$25 - $27/hr

Support Billing, VOB, Prior Authorization, and Collections teams with insurance research and payer-related inquiries. * Investigate claim status issues and identify payer-related root causes ...

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Waterfront Pharmacy

Pharmacy Technician

Stockton, CA

$18.50 - $22.50/hr

Knowledge of insurance adjudication and prior authorizations What We Offer: * Consistent weekday schedule * Supportive team environment * Competitive hourly pay (based on experience) If you are ...

Waterfront Pharmacy

Pharmacy Technician

Stockton, CA

$18.50 - $22.50/hr

Knowledge of insurance adjudication and prior authorizations What We Offer: * Consistent weekday schedule * Supportive team environment * Competitive hourly pay (based on experience) If you are ...

Golden State Dermatology

Practice Supervisor

Turlock, CA · On-site

$25 - $35/hr

Oversee insurance verification and prior authorization processes, ensuring timely approvals and minimizing billing issues. * Act as the primary liaison between the front office team, back office team ...

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All JobsPrior Authorization JobsPrior Authorization Jobs in Modesto, CA

Prior Authorization information

See Modesto, CA salary details

$14

$22

$33

How much do prior authorization jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for prior authorization in Modesto, CA is $22.04, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $24.33 per hour, depending on experience, location, and employer.

What is prior authorization?

Prior authorization is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication. Before the provider delivers the service, they must receive approval from the insurer. This process helps control costs and ensures that the service or medication is medically necessary. It often involves submitting documentation and waiting for a decision, which can sometimes delay patient care. Patients and providers should check with insurance companies to understand which services require prior authorization.

What are the key skills and qualifications needed to thrive as a prior authorization specialist, and why are they important?

To thrive as a Prior Authorization Specialist, you need strong knowledge of medical terminology, insurance processes, and healthcare regulations, typically supported by a high school diploma or associate degree in a healthcare-related field. Familiarity with electronic medical records (EMR) systems, insurance portals, and authorization management software is essential. Attention to detail, effective communication, and problem-solving abilities help you navigate complex cases and collaborate with providers and payers. These skills ensure accurate and timely processing of authorizations, minimizing delays in patient care and reducing administrative errors.

What are some common challenges faced by prior authorization specialists, and how can applicants prepare for them?

Prior Authorization specialists often encounter challenges such as navigating complex insurance policies, managing high volumes of requests, and communicating effectively with both healthcare providers and insurance representatives. To prepare for these challenges, applicants should develop strong organizational skills, attention to detail, and a good understanding of medical terminology and insurance guidelines. Familiarity with electronic health records (EHR) systems and the ability to multitask in a fast-paced environment are also valuable assets in this role.

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

AspectPrior AuthorizationMedical Billing Specialist
CredentialsTypically requires knowledge of insurance policies, healthcare regulations, and sometimes certifications like NCQA or AHIPRequires knowledge of coding, billing procedures, and often certifications like CPC or CCS
Work EnvironmentHealthcare provider offices, insurance companies, or hospitalsMedical offices, billing companies, or healthcare facilities
Employer & Industry UsageUsed by healthcare providers and insurers to approve treatments or proceduresUsed by healthcare providers and billing companies to process claims and payments

While both roles are essential in healthcare administration, Prior Authorization focuses on obtaining approval for treatments, whereas Medical Billing Specialists handle the financial aspects of claims processing. Understanding their differences helps clarify their distinct responsibilities within the healthcare system.

How do I become a prior authorization specialist?

To become a prior authorization specialist, you typically need a high school diploma or equivalent, along with knowledge of medical billing and coding. Relevant skills include attention to detail, communication, and familiarity with insurance policies and electronic health record systems. Certification in medical billing or coding can enhance job prospects.

What career paths follow prior authorization?

Careers following prior authorization include roles such as medical billers, claims processors, healthcare administrators, and utilization review specialists. These positions often require knowledge of insurance policies, medical coding, and healthcare regulations, and may involve certifications like CPC or CCS. Advancement can lead to supervisory or managerial roles within healthcare administration or insurance companies.

What is a prior authorization job?

A prior authorization job involves reviewing and processing requests from healthcare providers to approve specific medical treatments, medications, or procedures before they are administered. The role requires knowledge of insurance policies, medical terminology, and attention to detail, often utilizing electronic health record systems. It is essential for ensuring that treatments meet insurance criteria and are covered under the patient's plan.
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Prior Authorization jobs near you
Infographic showing various Prior Authorization job openings in Modesto, CA as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 23% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $45,850 per year, or $22 per hour.

Rehabilitation Services Authorization Coordinator

Boomerang Healthcare

Modesto, CA • On-site

$20.25 - $25.25/hr

Full-time

Posted 23 days ago

Job description

The role of the Authorization Coordinator is to execute all aspects of the auth process promptly, efficiently and accurately. 


What you will do:

  • Anticipate our customer needs: Understand the wants and needs of customers, listen for cues and identify how to respond and what level of intervention they need. 
  • Communicate effectively and interact with the provider group and health plans daily or as indicated regarding UM and referral authorization issues.
  • Fax or call-in prior authorizations requests.
  • Process requests that are approved,denied or deferred and bring them to resolution.
  • Responsible for deferred authorization maintenance, tracking and follow up. 
  • Returns phone calls to customers and follows up with requests. 
  • Maintain all reference material that is provided by the supervisor,manager,or director.  
  • Maintain patient confidentiality so that HIPAA compliance is always observed. 
  • Demonstrates honesty and integrity in everyday activities.
  • Recognizes when an error has been made and immediately reports to the appropriate manager.
  • Assists other staff and supports the team approach. 


Qualifications:

  • High School Diploma or equivalent
  • Excellent verbal and written communication skills
  • Ability to type 45+wpm
  • Proficient in Windows XP, Microsoft word, and Outlook
  • Ability to multi task and follow directives
  • Excellent with time management
  • Demonstrate professionalism in tasks and daily interactions with others
  • Efficient with time management 
  • Prior experience working in a medical setting

Compensation Range: 

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