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Prior Authorization Department

One Stop Hospice Inc

Santa Ana, CA

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JOB DETAILS
SKILLS
Clinical Study Publications, Communication Skills, Corporate Policies, Current Procedural Terminology (CPT), Customer Support/Service, Data Entry, Detail Oriented, Documentation, Electronic Medical Records, HIPAA (Health Insurance Portability and Accountability Act), Health Insurance, Healthcare, Healthcare Common Procedure Coding System (HCPCS), Healthcare Providers, High School Diploma, Home Care, Hospice Care, ICD-10, Insurance, Maintain Compliance, Medi-Cal, Medicaid, Medical Billing, Medical Coding, Medical Office, Medical Record System, Medical Terminology, Medical Treatment, Medicare, Medications, Microsoft Office, Multitasking, Nursing, Organizational Skills, Patient Confidentiality, Pharmacy, Problem Solving Skills, Regulatory Compliance, Time Management
LOCATION
Santa Ana, CA
POSTED
30+ days ago

Position Title


Prior Authorization Specialist / Prior Authorization Coordinator


Department


Prior Authorization Department

Job Summary


The Prior Authorization Specialist is responsible for obtaining insurance authorizations and approvals for medical services, treatments, medications, procedures, and equipment. This role works closely with physicians, clinical staff, insurance companies, and patients to ensure timely approvals and accurate documentation while maintaining compliance with payer guidelines and company policies.


Essential Duties and Responsibilities


  •  Submit prior authorization requests to insurance providers for medical services, medications, procedures, and treatments 
  •  Verify patient insurance eligibility and benefits 
  •  Review clinical documentation to ensure authorization requirements are met 
  •  Communicate with physicians, nurses, pharmacies, and other departments regarding authorization status and additional documentation needs 
  •  Follow up with insurance companies on pending, denied, or incomplete authorizations 
  •  Process authorization renewals and extensions as needed 
  •  Document all authorization activities accurately in the EMR/EHR system 
  •  Maintain knowledge of insurance payer guidelines, Medicare, Medicaid, and commercial insurance requirements 
  •  Assist with appeals and denial management when authorizations are denied 
  •  Ensure all approvals are obtained prior to scheduled services when required 
  •  Maintain confidentiality of patient information in compliance with HIPAA regulations 
  •  Provide excellent customer service to patients and internal staff 
Qualifications


  •  High school diploma or equivalent required; associate degree preferred 
  •  Minimum of 1–2 years of experience in healthcare, medical billing, insurance verification, or prior authorization preferred 
  •  Knowledge of medical terminology, CPT, ICD-10, and HCPCS coding preferred 
  •  Experience with EMR/EHR systems and insurance portals 
  •  Strong organizational and multitasking skills 
  •  Excellent communication and problem-solving abilities 
  •  Ability to work independently and in a fast-paced environment 
  •  Proficiency in Microsoft Office applications 
Preferred Experience


  •  Experience in Home Health, Hospice, Specialty Pharmacy, or Medical Office settings 
  •  Familiarity with Medicare, Medi-Cal/Medicaid, and commercial payer authorization processes 
Physical Requirements


  •  Prolonged periods of sitting and computer work 
  •  Ability to communicate effectively by phone and email 
  •  Occasional lifting of office materials up to 15 pounds 
Work Environment


  •  Office or healthcare setting 
  •  Standard business hours with occasional overtime depending on authorization volume 
Skills


  •  Attention to detail 
  •  Time management 
  •  Insurance verification and authorization processing 
  •  Data entry accuracy 
  •  Customer service 
  •  Team collaboration

About the Company

O

One Stop Hospice Inc

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