Top 19 Prior authorization specialist Jobs in Mission Viejo Ca

Medical Insurance Authorization Specialist
National Healthcare and Housing Advisors, LLC —Santa Ana, CA
- $73,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Sales
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9d
Authorization Specialist
Oso Home Care —Irvine, CA
- $21.00 - $25.90 an hour
- Full-time
- Background check
- Computer literacy
- Mid-level
- Health savings account
- Health insurance
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Medical Insurance Verification Specialist
Caring Cardiology Medical Group —Laguna Hills, CA
- $19 - $25 an hour
- Full-time
- Microsoft Outlook
- Writing skills
- English
- Health insurance
- Flexible schedule
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Intake Coordinator - Full-Time
Oso Home Care —Irvine, CA
- $26 - $33 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Medical office experience
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Patient Access Representative I - OC
City of Hope —Irvine, CA
- $22.73 - $30.23 an hour
- 8 hour shift
- Hospital
- High school diploma or GED
- Clinic
Patient Access Representative III - OC Per Diem
City of Hope —Irvine, CA
- $25.78 - $36.09 an hour
- Per diem
- Clinic experience
- Mid-level
- High school diploma or GED
Insurance Eligibility Specialist
Memorial Health Services —Fountain Valley, CA
- $22.89 - $33.18 an hour
- 8 hour shift
- Spanish
- Hospital
- HIPAA
- Health insurance
Reimbursement Specialist, Appeals
Lucid Diagnostics —Lake Forest, CA
- Full-time
- HIPAA
- Mid-level
- Bachelor's degree
- Employee stock purchase plan
- Paid holidays
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Pharmacy Prior Authorization Specialist
Infusion4Health Inc —Riverside, CA
- $22 - $30 an hour
- Full-time
- Microsoft Word
- Microsoft Outlook
- Mid-level
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Dental Front Office
Bruce M. Glover, DDS Inc. —Laguna Woods, CA
- $25 - $45 an hour
- Full-time
- Bilingual
- Dental office
- HIPAA
- Dental insurance
Quick Apply
Scheduling Specialist
MemorialCare Medical Foundation —Fountain Valley, CA
- $22.50 - $31.57 an hour
- 8 hour shift
- BLS Certification
- Mid-level
- Outpatient experience
- Health insurance
3d
Member Services Representative
Astiva Health —Orange, CA
- $24 - $29 an hour
- Call employer
- Spanish
- Mid-level
- 2 years
- Health insurance
- Dental insurance
Quick Apply
Claims Specialist
National Healthcare and Housing Advisors, LLC —Santa Ana, CA
- $26 an hour
- Full-time
- HIPAA
- Research
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
9d
Reimbursement Specialist
Oso Home Care —Irvine, CA
- $25 - $31 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Customer service
Quick Apply
Surgery Scheduler
Premier Orthopaedic Trauma Specialists —Placentia, CA
- $21 - $23 an hour
- Full-time
- Surgery
- Mid-level
- Clinic
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Billing and Credentialing Specialist
Clinivoy LLC —Irvine, CA
- $23 - $28 an hour
- Full-time
- HIPAA
- Clinic experience
- Research
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Sr. Medical Billing & Collections Specialist
Leaps & Bounds Pediatric Therapy —Norco, CA
- $27 - $35 an hour
- Weekends as needed
- Microsoft Outlook
- 5 years
- HIPAA
- Flexible schedule
Quick Apply
Biller IV - HB Patient Financial Services - FT Days
University of California, Irvine —Anaheim, CA
- $30.94 - $38.48 an hour
- Full-time
- Background check
- Mid-level
- Math
- Health insurance
- Retirement plan

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Based on your search for prior authorization specialist jobs.

Medical Insurance Verification Specialist
Caring Cardiology Medical Group —Laguna Hills, CA
Strong computer skills, proficiency in data entry and Microsoft programs such as Word, Excel, Outlook, Teams and Internet.
$19 - $25 an hour
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Insurance Verification Specialist III: Cancer Outpatient Treatment Center
Hoag Health System —Irvine, CA
Degree and/or certificate or formal training in related field preferred. Determines copayment and deductible amounts, maintains charge entry, and reconciles…

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Prior Authorization Specialist
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An associate's or bachelor's degree in human services, social work, or a related field is preferred. 2 years of experience in healthcare, behavioral health, or…
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Patient Financial Specialist III
Mount Carmel —Columbus, OH
Working knowledge of medical terminology, and data entry skills. Contacts physicians/office staff for clarification, if cases require clarification of diagnosis…
3d

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Medical Insurance Authorization Specialist

National Healthcare and Housing Advisors, LLC
Santa Ana, CA

Quick Apply

Job Details

Full-time
$73,000 a year
9 days ago

Qualifications

Health insurance authorizations
Microsoft Excel
Microsoft Outlook
Overseeing health insurance pre-certification
Medicare
Electronic health records (EHR) management
Phone communication
Medical insurance coverage verification
Phone call backs
Managed care organization experience
Spreadsheets
Maintaining patient confidentiality
HIPAA
High school diploma or GED
Client follow-up
Patient portals
Health information regulatory compliance
Medicaid
Managing patient records
Client interaction via phone calls

Full Job Description

The Authorizations Specialist is responsible for managing authorizations across multiple Medi-Cal managed care plans, monitoring authorization status, and ensuring timely reimbursement for services rendered. This role supports the revenue cycle by resolving authorization, eligibility, and admission-related discrepancies; reducing outstanding and aging authorizations; and escalating complex issues as needed. The ideal candidate is highly detail-oriented, organized, and persistent in follow-up efforts, with proficiency in health plan portals, electronic health record (EHR) systems, and Microsoft Excel. Strong communication skills and the ability to conduct consistent follow-up with health plans, providers, and stakeholders via phone and email are essential to success in this role.

Key Responsibilities

Submit, track, and manage authorization requests with Medi-Cal managed care plans and other payer sources to ensure timely approval of services.
Verify client eligibility, benefits, and authorization requirements prior to admission and service delivery.
Monitor authorization status through health plan portals, phone outreach, fax, and email correspondence; identify and resolve delays in processing.
Maintain accurate authorization records within the electronic health record (EHR), payer portals, spreadsheets, and internal tracking systems.
Review authorization aging reports and proactively work pending, expired, modified, denied, or unresolved authorizations to secure approval and reimbursement.
Contact health plans, payors, and utilization management departments to verify authorization status and address barriers to approval.
Research and resolve authorization denials, discrepancies, and documentation deficiencies by coordinating with clinical, admissions, billing, and care coordination teams.
Prepare and submit reconsiderations, retroactive authorization requests, and appeals with supporting documentation within required timelines.
Review service dates, approved units, levels of care, and authorization utilization to ensure services are accurately covered and documented.
Identify trends contributing to authorization delays, denials, or reimbursement issues and communicate findings to leadership.
Document all authorization activities, follow-up efforts, and payer communications thoroughly and accurately.
Collaborate with admissions, billing, coding, and program staff to resolve authorization-related discrepancies and support revenue cycle operations.
Escalate complex, high-dollar, compliance-related, or unresolved authorization issues to management as appropriate.
Assist with reimbursement reconciliation by identifying authorization-related variances between approved services and payments received.
Generate and maintain reports related to authorization status, aging authorizations, denials, approvals, and reimbursement trends.
Maintain compliance with HIPAA, payer requirements, contractual obligations, and organizational policies and procedures.
Assist with audits, record reviews, and documentation requests related to authorizations and reimbursement.
Identify opportunities to improve authorization workflows, reduce processing delays, and enhance operational efficiency.
Perform other duties as assigned in support of authorization management and revenue cycle operations.

Positions Requirements & Qualifications

Required Qualifications

High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, or a related field preferred.
Minimum of two (2) years of experience in healthcare authorizations, utilization management, medical billing, revenue cycle, or a related healthcare administrative role.
Experience working with Medi-Cal managed care plans, health insurance payors, and authorization processes.
Proficiency with electronic health record (EHR) systems, payer portals, Microsoft Excel, and other healthcare software applications.
Strong knowledge of insurance eligibility verification, authorization requirements, reimbursement processes, and healthcare documentation standards.
Excellent organizational skills with the ability to manage multiple priorities, deadlines, and high-volume workloads.
Strong analytical and problem-solving skills with attention to detail and accuracy.
Effective verbal and written communication skills, including the ability to communicate professionally with health plans, providers, and internal stakeholders.
Ability to work independently, exercise sound judgment, and maintain confidentiality.
Knowledge of HIPAA regulations and healthcare compliance requirements.

Preferred Qualifications

Experience in recuperative care, care management, behavioral health, homeless services, or community-based healthcare programs.
Familiarity with Community Supports, or Medi-Cal managed care plan operations.
Experience preparing authorization appeals, retroactive authorization requests, and payer escalations.
Working knowledge of revenue cycle management and reimbursement processes.

Additional Preferred Skills

Sales, account management, customer service, or business development experience strongly preferred, with the ability to build relationships, conduct persistent follow-up, navigate challenging conversations, and effectively advocate with health plans and external partners.
Demonstrated ability to negotiate, influence outcomes, and maintain professional relationships while working toward authorization approvals and issue resolution.

Pay: $73,000.00 per year

Work Location: In person

Quick Apply

Refine Your Search

prior authorization specialist jobs in mission viejo ca

Medical Insurance Authorization Specialist

Authorization Specialist

Medical Insurance Verification Specialist

Intake Coordinator - Full-Time

Patient Access Representative I - OC

Patient Access Representative III - OC Per Diem

Insurance Eligibility Specialist

Reimbursement Specialist, Appeals

Pharmacy Prior Authorization Specialist

Dental Front Office

Scheduling Specialist

Member Services Representative

Claims Specialist

Reimbursement Specialist

Surgery Scheduler

Billing and Credentialing Specialist

Sr. Medical Billing & Collections Specialist

Biller IV - HB Patient Financial Services - FT Days

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