Medical Insurance Authorization Specialist

Medical Insurance Authorization Specialist National Healthcare and Housing Advisors, LLC Santa Ana, CA Job Details Full-time $73,000 a year 4 hours ago Qualifications Health insurance authorizations Microsoft Excel Microsoft Outlook Overseeing health insurance pre-certification Medicare Electronic health records (EHR) management Phone communication Medical insurance coverage verification Phone call backs Managed care organization experience Spreadsheets Maintaining patient confidentiality HIPAA High school diploma or GED Client follow-up Patient portals Health information regulatory compliance Medicaid Managing patient records Client interaction via phone calls Full Job Description The Authorizations Specialist is responsible for managing authorizations across multiple Medi-Cal managed care plans, monitoring authorization status, and ensuring timely reimbursement for services rendered. This role supports the revenue cycle by resolving authorization, eligibility, and admission-related discrepancies; reducing outstanding and aging authorizations; and escalating complex issues as needed. The ideal candidate is highly detail-oriented, organized, and persistent in follow-up efforts, with proficiency in health plan portals, electronic health record (EHR) systems, and Microsoft Excel. Strong communication skills and the ability to conduct consistent follow-up with health plans, providers, and stakeholders via phone and email are essential to success in this role. Key Responsibilities Submit, track, and manage authorization requests with Medi-Cal managed care plans and other payer sources to ensure timely approval of services. Verify client eligibility, benefits, and authorization requirements prior to admission and service delivery. Monitor authorization status through health plan portals, phone outreach, fax, and email correspondence; identify and resolve delays in processing. Maintain accurate authorization records within the electronic health record (EHR), payer portals, spreadsheets, and internal tracking systems. Review authorization aging reports and proactively work pending, expired, modified, denied, or unresolved authorizations to secure approval and reimbursement. Contact health plans, payors, and utilization management departments to verify authorization status and address barriers to approval. Research and resolve authorization denials, discrepancies, and documentation deficiencies by coordinating with clinical, admissions, billing, and care coordination teams. Prepare and submit reconsiderations, retroactive authorization requests, and appeals with supporting documentation within required timelines. Review service dates, approved units, levels of care, and authorization utilization to ensure services are accurately covered and documented. Identify trends contributing to authorization delays, denials, or reimbursement issues and communicate findings to leadership. Document all authorization activities, follow-up efforts, and payer communications thoroughly and accurately. Collaborate with admissions, billing, coding, and program staff to resolve authorization-related discrepancies and support revenue cycle operations. Escalate complex, high-dollar, compliance-related, or unresolved authorization issues to management as appropriate. Assist with reimbursement reconciliation by identifying authorization-related variances between approved services and payments received. Generate and maintain reports related to authorization status, aging authorizations, denials, approvals, and reimbursement trends. Maintain compliance with HIPAA, payer requirements, contractual obligations, and organizational policies and procedures. Assist with audits, record reviews, and documentation requests related to authorizations and reimbursement. Identify opportunities to improve authorization workflows, reduce processing delays, and enhance operational efficiency. Perform other duties as assigned in support of authorization management and revenue cycle operations. Positions Requirements & Qualifications Required Qualifications High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field preferred. Minimum of two (2) years of experience in healthcare authorizations, utilization management, medical billing, revenue cycle, or a related healthcare administrative role. Experience working with Medi-Cal managed care plans, health insurance payors, and authorization processes. Proficiency with electronic health record (EHR) systems, payer portals, Microsoft Excel, and other healthcare software applications. Strong knowledge of insurance eligibility verification, authorization requirements, reimbursement processes, and healthcare documentation standards. Excellent organizational skills with the ability to manage multiple priorities, deadlines, and high-volume workloads. Strong analytical and problem-solving skills with attention to detail and accuracy. Effective verbal and written communication skills, including the ability to communicate professionally with health plans, providers, and internal stakeholders. Ability to work independently, exercise sound judgment, and maintain confidentiality. Knowledge of HIPAA regulations and healthcare compliance requirements. Preferred Qualifications Experience in recuperative care, care management, behavioral health, homeless services, or community-based healthcare programs. Familiarity with Community Supports, or Medi-Cal managed care plan operations. Experience preparing authorization appeals, retroactive authorization requests, and payer escalations. Working knowledge of revenue cycle management and reimbursement processes. Additional Preferred Skills Sales, account management, customer service, or business development experience strongly preferred, with the ability to build relationships, conduct persistent follow-up, navigate challenging conversations, and effectively advocate with health plans and external partners. Demonstrated ability to negotiate, influence outcomes, and maintain professional relationships while working toward authorization approvals and issue resolution.

Pay:

$73,000.00 per year

Work Location:

In person