Insurance Authorizations

Description We are looking for a skilled Prior Authorization Specialist to support healthcare operations in Brea, California. This role involves ensuring insurance approvals for medical services, diagnostic testing, and treatments, as well as maintaining compliance with payer guidelines. As a long-term contract to hire position, this opportunity offers stability and the chance to contribute to patient care in a meaningful way.

Key Responsibilities:

• Review clinical documentation, physician orders, and patient charts to identify insurance authorization requirements.
• Submit and track prior authorization requests for treatments, medications, procedures, and diagnostic tests.
• Verify insurance eligibility, benefits, and coverage details to ensure patients receive appropriate care.
• Act as a liaison between insurance providers, healthcare teams, and patients to communicate authorization statuses.
• Follow up on pending authorizations, addressing inquiries or resolving denials as needed.
• Maintain detailed records of approvals, denials, and supporting documentation in electronic health systems.
• Collaborate with clinical and scheduling teams to confirm services are authorized before they are provided.
• Monitor updates to payer policies and guidelines to ensure compliance with insurance requirements.
• Initiate appeals for denied authorization requests when justified.
• Uphold confidentiality standards and organizational compliance in all aspects of patient care.

Benefits:

Medical, Dental and Vision Insurance. 401K Retirement, Sick Time Off and Tuition Reimbursement.

Requirements Qualifications:

• Minimum of 1 year of experience in insurance authorization or a related healthcare role.
• Familiarity with payer guidelines and prior authorization processes.
• Strong organizational skills with the ability to manage multiple tasks and deadlines.
• Effective communication skills to interact with insurance providers, healthcare teams, and patients.
• Proficiency in electronic health record systems and documentation.
• Ability to interpret clinical documentation and insurance requirements accurately.
• Knowledge of healthcare terminology and insurance policies.
• Commitment to maintaining patient confidentiality and compliance with regulations.

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