Top 42 Prior authorization specialist Jobs in Orange 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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5d
Prior Authorization Specialist
Infusion4Health Inc —Brea, CA
- $22 - $27 an hour
- Full-time
- Microsoft Word
- Mid-level
- Office
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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
Quick Apply
Prior Auth Coordinator
REGAL MEDICAL GROUP, INC —Orange, CA
- $23 - $25 an hour
- Overtime
- Microsoft Outlook
- Word processing
- Medical office experience
- Continuing education credits
- Paid holidays
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Insurance Eligibility Specialist
Memorial Health Services —Fountain Valley, CA
- $22.89 - $33.18 an hour
- 8 hour shift
- Spanish
- Hospital
- HIPAA
- Health insurance
Pharmacy Prior Authorization Specialist
Infusion4Health Inc —Riverside, CA
- $22 - $30 an hour
- Full-time
- Microsoft Word
- Microsoft Outlook
- Mid-level
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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
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
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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Financial Clearance Specialist
City of Hope —Irwindale, CA
- $25.02 - $35.03 an hour
- Full-time
- Hospital
- Mid-level
- High school diploma or GED
5d
Patient Registration Rep
St Mary Medical Center —Long Beach, CA
- $25.05 - $31.47 an hour
- PRN
- Medical office experience
- HIPAA
- High school diploma or GED
Reimbursement Specialist
Oso Home Care —Irvine, CA
- $25 - $31 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Basic math
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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
5d
Intake Specialist
SpecialtyCare Rx —Diamond Bar, CA
- $30 - $35 an hour
- Full-time
- Management
- Mid-level
- Office
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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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Coordinator , UM DME -Orange , CA (Temporary )
REGAL MEDICAL GROUP, INC —Orange, CA
- $23 - $25 an hour
- Temporary
- Microsoft Outlook
- Medical office experience
- HIPAA
- Paid time off
- Parental leave
Quick Apply
Member Services Representative
Astiva Health —Orange, CA
- $24 - $29 an hour
- Call employer
- Spanish
- Mid-level
- 2 years
- Health insurance
- Dental insurance
Quick Apply
Release of Information Specialist
Vital Holdings LLC —Los Angeles, CA
- HIPAA
- Windows
- High school diploma or GED
Quick Apply
Medical Billing & Collections - Account Specialist
Leaps & Bounds Pediatric Therapy Inc —Norco, CA
- $27 - $35 an hour
- Weekends as needed
- Hybrid work
- Microsoft Outlook
- 5 years
- HIPAA
- Flexible schedule
Quick Apply
6d
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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Medical Insurance Authorization Specialist

National Healthcare and Housing Advisors, LLC
Santa Ana, CA

Quick Apply

Job Details

Full-time
$73,000 a year
5 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 orange ca

Medical Insurance Authorization Specialist

Prior Authorization Specialist

Authorization Specialist

Prior Auth Coordinator

Insurance Eligibility Specialist

Pharmacy Prior Authorization Specialist

Patient Access Representative III - OC Per Diem

Patient Access Representative I - OC

Medical Insurance Verification Specialist

Financial Clearance Specialist

Patient Registration Rep

Reimbursement Specialist

Claims Specialist

Intake Specialist

Reimbursement Specialist, Appeals

Coordinator , UM DME -Orange , CA (Temporary )

Member Services Representative

Release of Information Specialist

Medical Billing & Collections - Account Specialist

Biller IV - HB Patient Financial Services - FT Days

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