Prior Authorizations Specialist

Prior Authorizations Specialist

UNITED MEDICAL DOCTORS MASTER

Carlsbad, CA Job Details Full-time $23 - $28 an hour 1 hour ago Qualifications Availity Appeals Overseeing health insurance pre-certification Medicare Commercial insurance knowledge Managed care Medical insurance coverage verification Pain management Care documentation Mid-level 3 years Medicaid health insurance Case appeal in utilization management Task prioritization Medical billing and coding communication with insurance companies Clinical documentation Documentation Handling Insurance claims appeal handling Communication skills Time management Full Job Description We are seeking an experienced and detail-oriented Prior Authorization Specialist to join our growing team. The ideal candidate will have extensive knowledge of insurance authorization processes across multiple specialties and the ability to manage high-volume requests for several clinic locations. This role requires a proactive professional who can work independently, communicate effectively with providers and insurance carriers, and ensure timely approvals to support quality patient care. Responsibilities Submit and track prior authorization requests for: GI procedures Pain management services Imaging studies Urology and cardiology services as needed Verify insurance eligibility and benefits Obtain and document authorizations accurately and efficiently Follow up with insurance companies regarding pending, delayed, or denied requests Coordinate with physicians, clinical staff, and scheduling teams across multiple locations Maintain accurate documentation within the EMR system Ensure compliance with payer guidelines and company policies Assist with appeals, reconsiderations, and peer-to-peer coordination when necessary Prioritize urgent requests while maintaining high accuracy standards Utilize insurance and imaging/pre-certification portals to process and manage authorizations, including platforms such as Availity, RadMD, eviCore, Carelon/AIM, and other payer-specific portals Minimum 3+ years of prior authorization experience in a medical setting Experience handling multiple specialties required Strong understanding of commercial insurance, Medicare, Medi-Cal, and managed care plans Knowledge of GI, pain management, imaging, urology, and cardiology authorizations preferred Familiarity with imaging and pre-certification insurance portals such as Availity, RadMD, eviCore, AIM/Carelon, and payer-specific portals Ability to manage authorizations for multiple clinic locations simultaneously Excellent organizational and time-management skills Strong verbal and written communication skills EMR/EHR experience required Ability to work independently and in a fast-paced environment