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Prior Authorization Jobs in Riverside, CA (NOW HIRING)

Specialty Care Rx

Intake Specialist

Walnut, CA · On-site

$18.50 - $24.75/hr

... authorization status of insured prior to service being provided. 4. Ensures compliance with local and federal regulations, accreditation standards and corporate policies to drive effectiveness and ...

Kaizen Stackup

Account Executive

Brea, CA

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Kaizen Stackup

Account Executive

Irvine, CA · On-site

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Kaizen Stackup

Account Executive

Santa Ana, CA · On-site

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Kaizen Stackup

Account Executive

Lake Forest, CA · On-site

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Kaizen Stackup

Account Executive

Irvine, CA

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Kaizen Stackup

Account Executive

Santa Ana, CA · On-site

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Kaizen Stackup

Account Executive

Irvine, CA

$100K - $150K/yr

President's Club wins or quota achievement recognition RN or clinical background -- gives you instant credibility in the room Deep familiarity with prior authorization processes and specialty ...

Specialty Care Rx

Pharmacy Intake Coordinator

Orange, CA · On-site

$24 - $30/hr

Obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed.

Spiniello

Office Manager / Project Coordinator

Pomona, CA · On-site

$65K - $75K/yr

... work authorization * Assist with shipping and receiving of packages and deliveries * Other duties as necessary Position Requirements and Qualifications * 5-7 years of prior experience an Office ...

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All JobsPrior Authorization JobsPrior Authorization Jobs in Riverside, CA

Prior Authorization information

See Riverside, CA salary details

$14

$21

$33

How much do prior authorization jobs pay per hour?

As of Jun 12, 2026, the average hourly pay for prior authorization in Riverside, CA is $21.80, according to ZipRecruiter salary data. Most workers in this role earn between $18.08 and $24.09 per hour, depending on experience, location, and employer.

How much do precertification specialists make?

Precertification specialists typically earn a median annual salary between $40,000 and $55,000, depending on experience, location, and employer. They often require knowledge of insurance policies and medical billing software, with some roles offering additional certifications to increase earning potential.

What Is Prior Authorization?

Prior authorization is a check done by insurance companies and other third-party payers to determine whether or not they should pay for a medical procedure or specific medication. Factors that can trigger prior authorization requests include things like age, the availability of alternative medicines, or the need to check for drug interactions. If they reject the prior authorization, payers often require doctors to attempt the insurance company's preferred procedure and verify unsuccessful results before accepting an alternative treatment plan. Pre-authorization requests can take up to 30 days, though insurance companies and healthcare providers are continuing to work on ways to cut this time down.

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.

What does a prior authorization job do?

A prior authorization specialist reviews and processes requests for approval of medical procedures, medications, or treatments from insurance companies. They verify patient information, ensure documentation is complete, and communicate with healthcare providers and insurers to obtain necessary approvals, often using electronic health record systems. This role helps ensure that necessary care is authorized while complying with insurance policies.

What job makes $10,000 a month without a degree?

High-paying jobs that can reach $10,000 a month without a degree include roles like sales managers, real estate brokers, or certain skilled trades such as electricians or plumbers, especially with experience and certifications. These positions often require strong skills, industry knowledge, and sometimes licensing, but not necessarily a college degree.

What is prior authorization in healthcare?

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 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 working in insurance companies, healthcare providers, or pharmacy benefit management companies.
More about Prior Authorization jobs
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:
What are popular job titles related to Prior Authorization jobs in Riverside, CA? For Prior Authorization jobs in Riverside, CA, the most frequently searched job titles are:
What job categories do people searching Prior Authorization jobs in Riverside, CA look for? The top searched job categories for Prior Authorization jobs in Riverside, CA are:
What cities near Riverside, CA are hiring for Prior Authorization jobs? Cities near Riverside, CA with the most Prior Authorization job openings:
Prior Authorization jobs near you
Member Services Specialist (Bilingual - Spanish)

Member Services Specialist (Bilingual - Spanish)

Astiva Health, Inc

Anaheim, CA

$18.25 - $23.50/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 12 days ago

Job description

About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.


SUMMARY: The Member Service Specialist is responsible for answering telephonic inquiries from current and potential members and providers regarding Medicare Advantage benefits, eligibility, enrollment, claims, referral, prior authorizations, appeals & grievances and other related concerns. Our Member Service Specialists ensure customer satisfaction by providing excellent customer service, displaying a desire to help and maintaining a professional demeanor. Member Service Specialists will be expected to maintain quality and performance standards.


ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

  • Handle inbound and outbound phone calls, emails and other necessary communications with members and providers
  • Clearly identify and act on customer needs to achieve satisfaction.
  • Clearly explain all details of the Medicare Advantage Plan including procedures, protocols, benefits, and any other necessary information to the member or provider during inbound and outbound calls.
  • Fully understand all aspects of Medicare Advantage including but not limited to benefits, prior authorization, referrals, claims, enrollment, eligibility, appeals & grievances, providers networks and pharmacy services.
  • Provide accurate and complete information using the tools provided
  • Keep detailed written records of each telephone encounter during the call
  • Adhere to all call center metrics as set forth by CMS regulation and call center leadership.
  • Attempt to resolve the member’s issue completely during the first phone call.
  • Go above and beyond to provide exceptional customer service.


EDUCATION and/or EXPERIENCE:

  • 2+ years customer service experience
  • Minimum 1+ years’ experience with Medicare Advantage
  • Health Plan experience.
  • Excellent verbal and written communication skills including active listening and probing techniques.
  • Ability to multi-tasks, time manage and prioritize.
  • Ability to document information while on the phone with the member.
  • Ability to build rapport with members
  • Fluent in Spanish (verbal and written)


BENEFITS:

  • 401(k)
  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Vision Insurance
  • Paid Time Off
  • Free catered lunches

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