Prior Authorizations Specialist California

Our client is looking for a reliable and detail-oriented person to join their team as a Prior Authorization Representative. In this role, you will help our medical team process insurance requests to make sure patients get the healthcare services they need on time. You will be responsible for entering data, checking medical documents, and making sure all paperwork follows the right rules and deadlines. If you have a background in the medical field and are good at staying organized, we would love to hear from you. CANDIDATES MUST BE LOCATED IN THE STATE OF CALIFORNIA FOR CONSIDERATION Schedule: Tuesday - Saturday: 8:00 a.m. to 5:00 p.m. salary: $20 - $21 per hour shift: First work hours: 8 AM - 5 PM education: High School

Responsibilities

• Support the prior authorization request lifecycle to ensure all requests are addressed accurately and within required legal and contractual timeframes.
• Perform high-volume data entry to maintain and update authorization requests within the utilization management system, ensuring information is current and accessible.
• Review medical documents received via fax and electronic systems to extract specific data points needed to build a comprehensive authorization file.
• Prepare files for the clinical review team by documenting necessary medical information, including patient history, diagnosis, and prognosis.
• Perform outreach to healthcare providers to obtain missing information or clarify request details; maintain professional verbal and written communication at all times.
• Assist the team with ongoing tracking of authorizations and referrals, ensuring all actions comply with internal policies, medical guidelines, and insurance standards.
• Create and send out official determination letters to providers and members, adhering to strict deadlines and quality standards.

The essential functions of this role include:

• working weekends

Skills

• Medical Terminology
• Medicare/Medicaid
• Data Entry
• Written Communication
• Excel

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

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