Find & Apply For Enrollment / Eligibility Specialist Jobs in Carmel-by-the-Sea, California

We are seeking a detail-oriented Insurance Authorization Specialist to support the timely review, submission, and follow-up of prior authorizations and insurance verification activities. This role is responsible for working with patients, providers, and insurance carriers to secure authorizations for services, procedures, and treatments while ensuring accuracy, compliance, and excellent customer service.

Hours:

Monday - Friday 8am - 5pmKey ResponsibilitiesObtain and process prior authorizations for medical procedures, treatments, medications, and specialty servicesVerify patient insurance eligibility, benefits, coverage limitations, and authorization requirementsCommunicate with insurance companies, physician offices, clinical staff, and patients regarding authorization statusSubmit accurate clinical documentation and required forms to payers within established timelinesTrack pending authorizations and follow up to ensure timely approvals or denialsReview denied requests and assist with appeals or resubmissions as neededMaintain detailed and accurate records in the electronic medical record and billing systemsEnsure compliance with payer guidelines, HIPAA, and internal policiesIdentify authorization issues that may impact scheduling, billing, or reimbursement and escalate as appropriateProvide updates to internal teams regarding authorization outcomes and next steps