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Remote Prior Authorization Jobs in California (NOW HIRING)

Adecco

Authorization Coordinator

Menlo Park, CA · Remote

$28/hr

Remote Authorization Coordinator Adecco Healthcare & Life Sciences is hiring an Authorization ... Strong knowledge of insurance verification and prior authorization processes. * Excellent ...

Inspire Healthcare

Medical Director Physician

Pomona, CA · Remote

$250K - $350K/yr

We are seeking a Remote Medical Director for a non-clinical role focused on prior authorization and medical necessity reviews. No direct patient care is required. Candidates must reside in the LAarea ...

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Remote Prior Authorization information

What are remote prior authorization jobs?

Remote prior authorization jobs involve reviewing and processing requests from healthcare providers to determine if specific medical treatments, medications, or procedures are covered by a patient's insurance plan. Employees in these roles work from home, utilizing online systems to evaluate clinical information, communicate with providers, and ensure compliance with insurance policies. This position requires a strong understanding of medical terminology, insurance guidelines, and attention to detail to facilitate timely and accurate approvals or denials. Remote prior authorization specialists help streamline patient care by acting as a liaison between healthcare providers and insurance companies.

What are some common challenges faced by Remote Prior Authorization specialists, and how can they be addressed?

Remote Prior Authorization specialists often encounter challenges such as navigating complex insurance requirements, managing high volumes of requests, and maintaining clear communication with healthcare providers and payers. Staying organized and up-to-date on payer policies is crucial, as requirements can vary widely between insurers. Utilizing workflow management tools and fostering strong collaboration with clinical and administrative teams can help streamline processes and reduce delays, ultimately ensuring patients receive timely care.

What are the key skills and qualifications needed to thrive as a Remote Prior Authorization Specialist, and why are they important?

To thrive as a Remote Prior Authorization Specialist, you need a solid understanding of medical terminology, insurance processes, and healthcare regulations, often supported by experience in medical billing or coding. Familiarity with electronic health record (EHR) systems, insurance portals, and prior authorization software is typically required. Attention to detail, strong organizational skills, and effective communication are crucial soft skills in this role. These skills ensure timely and accurate processing of authorizations, reducing claim denials and supporting efficient patient care.

What is the difference between Remote Prior Authorization vs Remote Medical Coder?

AspectRemote Prior AuthorizationRemote Medical Coder
Required CredentialsMedical credentials, insurance knowledgeMedical coding certification (CPC, CCS)
Work EnvironmentHealthcare offices, insurance companies, remoteHealthcare facilities, remote coding jobs
Industry UsageInsurance, healthcare providersHospitals, clinics, billing companies
Job FocusReviewing and approving insurance requestsTranslating medical records into codes

Remote Prior Authorization and Remote Medical Coder roles both operate within the healthcare industry but focus on different tasks. Remote Prior Authorization involves reviewing insurance requests for coverage approval, requiring insurance and medical knowledge. Remote Medical Coders translate medical records into standardized codes, primarily focusing on billing and documentation. Both roles can be performed remotely and require healthcare-related credentials, but their daily responsibilities and skill sets differ significantly.

What Are Remote Prior Authorization Jobs?

Remote prior authorization jobs focus on working with insurance companies to coordinate benefit coverage and get approval to provide care for a patient. In this pre-authorization role, you may collect documentation and proof of insurance, perform data entry, help evaluate the need for a particular process, and otherwise work from home to help manage the prior authorization process. Remote prior authorization personnel often answer telephone calls to provide consultations, perform initial benefit verification, document case status, actions, and outcomes in a database, and use customer service skills to help expedite cases as needed. Since this is a remote call center-style job, you may be asked to arrange for a quiet office in your house that is free of distractions.

More about Remote Prior Authorization jobs
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 Remote Prior Authorization jobs in California? For Remote Prior Authorization jobs in California, the most frequently searched job titles are:
What job categories do people searching Remote Prior Authorization jobs in California look for? The top searched job categories for Remote Prior Authorization jobs in California are:
What cities in California are hiring for Remote Prior Authorization jobs? Cities in California with the most Remote Prior Authorization job openings:
Remote Prior Authorization jobs near you
Infographic showing various Remote Prior Authorization job openings in California as of July 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.
Senior Central Prior Authorization Analyst

Senior Central Prior Authorization Analyst

Adventist Health

Roseville, CA • On-site, Remote

$30.91 - $40.33/hr

Full-time

Posted 2 days ago

Adventist Health rating

7.8

Company rating: 7.8 out of 10

Based on 242 frontline employees who took The Breakroom Quiz

131st of 890 rated healthcare providers

Job description


Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Serves as a subject matter expert and strategic partner in optimizing infusion site-of-care decisions, pharmacy access, and revenue integrity. This role operates with a high degree of autonomy and is responsible not only for executing complex workflows, but also for leading process improvement initiatives, influencing cross-functional stakeholders, and driving measurable financial and operational outcomes. In coordination with financial clearance, pharmacy, and clinical teams, this role evaluates and determines the most appropriate infusion site of care based on clinical appropriateness, payer policy, and financial impact. The Senior Analyst leverages advanced analytics, deep payer knowledge, and system-wide insights to optimize patient access, minimize denials, and maximize reimbursement across the continuum of care.
Job Requirements:
Education and Work Experience:
  • High School Education/GED or equivalent: Preferred
  • Associate's/Technical Degree or equivalent combination of education/related experience: Preferred
  • Six years' of progressive experience in infusion, specialty pharmacy, revenue cycle, or related healthcare operations: Required
  • Experience in Epic or similar electronic medical records (EMR) platforms: Preferred
  • Knowledge of healthcare insurance, prior authorization and/or coding: Preferred

Licenses/Certifications:
  • State Pharmacy Technician license (CA, OR, &/or HI): Preferred
  • Pharmaceutical Technician Board certification: Preferred
  • Advanced certification (e.g., CHRI, CRCR, or 340B ACE): Preferred
  • Pharmaceutical Technician Board certification: Preferred

Essential Functions:
  • Serves as the lead subject matter expert for infusion site-of-care strategy, payer requirements, and pharmacy benefit optimization. Independently evaluate complex patient cases to determine optimal infusion site of care, balancing clinical appropriateness, payer constraints, and financial impact. Lead coordination with central financial clearance, pharmacy operations, and clinical teams to ensure seamless referral routing across home infusion, ambulatory infusion, and alternate care sites.
  • Oversee and perform advanced benefit investigation, prior authorization strategy, and denials resolution, including escalation of high-risk or high-dollar cases. Identify trends in denials, payer behavior, and workflow inefficiencies; develop and implement data-driven process improvements. Act as a strategic liaison between pharmacy, revenue cycle, and clinical operations to enhance patient access and optimize reimbursement.
  • Provide guidance, training, and mentorship to analysts and technicians; serve as an escalation point for complex issues. Drive standardization of workflows, documentation practices, and referral processes across the health system. Promote and articulate the value of the infusion hub model and site-of-care strategy to internal and external stakeholders. Build and maintain strong relationships with physicians, clinic leadership, pharmacy teams, and payers.
  • Act as a financial advocate for patients, leveraging manufacturer assistance programs, foundations, and alternative funding sources. Participate in or lead cross-functional projects, pilots, and system implementations related to pharmacy services and revenue optimization. Ensure compliance with regulatory requirements (e.g., CMS, payer policies, 340B considerations where applicable).
  • Provide coverage support while maintaining oversight of broader program performance and service delivery. Assesses, develops, and recommends the best method of providing ambulatory infusion pharmacy services to support patients based on health system guidance. Develops and maintains close relationships with clinic staff, physician, pharmacy and other hospital contacts. Independently, and working hand in hand with client authorization resources, facilitates benefits verification and prior authorizations services for infusion site of care patients.
  • Performs other job-related duties as assigned.

Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
About Us
Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

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