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
