Medical Prior Authorization Specialist

Medical Prior Authorization Specialist Paloma Medical Partners•A California General Partnership San Juan Capistrano, CA Job Details Full-time $21•$26 an hour 23 hours ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance Qualifications Customer communication HIPAA Administrative experience Attention to detail Clinical documentation Organizational skills

Full Job Description Medical Prior Authorization Specialist, Paloma Medical Group Compensation:

$21.00•26.00 per hour, depending on experience. Higher rates may be considered for candidates with extensive prior authorization experience, appeals management, and knowledge of California HMO plans. Paloma Medical Group is seeking a detail-oriented and highly organized Prior Authorization Specialist to join our growing healthcare team. This position plays a critical role in ensuring patients receive timely access to medications, diagnostic testing, procedures, and specialty services by obtaining insurance authorizations and coordinating with providers, patients, and insurance carriers. Responsibilities Submit and track prior authorization requests for medications, imaging, procedures, and specialty referrals. Verify insurance benefits and authorization requirements. Communicate with insurance companies regarding authorization status, appeals, and denials. Work closely with providers and clinical staff to obtain supporting documentation. Follow up on pending authorizations to ensure timely approvals. Document all authorization activity accurately in the electronic health record (EHR). Assist patients with questions regarding authorization status and insurance requirements. Identify and resolve authorization-related issues to minimize delays in patient care. Maintain compliance with HIPAA and payer guidelines. Qualifications Minimum 1 year of prior authorization, medical billing, referrals, or healthcare administrative experience preferred. Knowledge of HMO, PPO, Medicare, and Medi-Cal insurance plans. Experience working with electronic health records (ECW experience preferred). Strong understanding of medical terminology and healthcare workflows. Excellent organizational skills and attention to detail. Strong communication and customer service skills. Ability to manage multiple priorities in a fast-paced medical office environment. Preferred Skills Experience with specialty medications and chronic disease management programs. Familiarity with insurance appeals and denial management. Ability to work independently while collaborating effectively with providers and staff. What We Offer Competitive compensation Supportive team environment Opportunities for professional growth Meaningful work helping patients access necessary medical care At Paloma Medical Group, we believe patients deserve seamless access to healthcare. Join our team and make a meaningful difference by helping patients navigate the authorization process so they can receive the care they need without unnecessary delays.

Pay:

$21.00•$26.00 per hour

Benefits:

401(k) Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person