Prior Authorization Specialist Job at Robert Half (Brea)

Prior Authorization Specialist

PHIL is looking for a full-time Prior Authorization Specialist - with a focus on...

Location

United States

Salary:

21.00 - 25.00 USD / Hour

PHIL

Expiration Date

Until further notice

Requirements

Proven team player, but can solve problems independently as well
Exceptional written and verbal communication skills
Easily adapt to new system and workflow changes
Demonstrate experience working in prior authorizations, medical insurance billing, and/or health insurance (required)
Working knowledge of ICD-10 codes and prescription drug names (preferred, but not required)
Ability to successfully navigate between multiple systems throughout the course of the workday, this includes but is not limited to operational software and vendor portals
Demonstrate flexibility to perform duties wherever volume deems it necessary
Customer service experience (preferred)
Access to reliable, high-speed internet to meet the needs of remote processing (required)

Job Responsibility

Verifies patient insurance coverage utilizing phone or online resources
Submit prior authorizations to insurance plans in a timely manner via electronic portal
Troubleshoots prior authorization submissions and prescription processing with health care providers utilizing phone or online resources
Verbally assist providers in navigating appeals processing
Ensures all pertinent medical documentation is accurate and present prior to authorization submission
Compiles trends in authorization determinations for client and prescriber education
Document activities appropriately in process notes using our operating system
Work closely with our Customer Support team to ensure the success of patients that are recommended to us by their physician's office

What we offer

Ground floor opportunity with one of the fastest-growing startups in health-tech
Solve a problem that matters: be part of a company that uniquely leverages technology to bring wellness to all of its stakeholders

Parttime

Senior Field Reimbursement Specialist

Under general supervision of a Senior Manager, the Sr Field Reimbursement Specia...

Location

United States , Remote

Salary:

100700.00 - 155100.00 USD / Year

Cencora

Expiration Date

Until further notice

Requirements

Experience related and progressively responsible in a medical practice, private or third-party reimbursement arena, or pharmaceutical industry in sales, managed care, or clinical support
Experience within healthcare provider support such as a physician practice, patient assistance program or similar pharmaceutical/biological support program experience preferred
Bachelor’s degree preferred
Minimum of 7 years of experience
Candidates must possess a Prior Authorization Certification Specialist (PACS) credentials from an industry approved licensing body, or obtain certification within the first six months of employment
Ability to effectively manage multiple client relationships and customer
Ability to manage and support external meetings, presentations, and client interactions
Ability to lead and work in a matrix environment
Proven teamwork and collaboration skills with a demonstrated record of accomplishment of working in highly matrixed and cross-functional organizations
Ability to manage multiple tasks, timelines, expenses, and other activities necessary to fulfill the roles and responsibilities of a Field Reimbursement Specialists

Job Responsibility

Plan and engage with customers, leveraging client approved resources, to educate on access and reimbursement topics relevant to assigned client’s product
Track progress and evaluate results of assigned activities
Recommends changes in procedures
Lead or direct more complex projects or certain aspects of projects
Operates with reasonable latitude for un-reviewed action or decision
Work within a matrix environment to collaborate with internal and external stakeholders to secure optimized patient access and provide appropriate education through a focused effort on healthcare providers in community, institutional, and academic medical settings
Manage daily activities that support appropriate patient access to our client’s products in the provider offices and healthcare institutions, working as a liaison to other patient assistance and reimbursement support services offered by our clients
Review patient insurance benefit options with appropriate authorizations
Validate prior authorization requirements
Understanding of Specialty Pharmacy processes

What we offer

medical
dental
vision care
comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness
support for working families
backup dependent care
adoption assistance
infertility coverage
family building support
behavioral health solutions

Fulltime

Referral and prior authorization representative iii

As a community, the University of Rochester is defined by a deep commitment to M...

Location

United States of America , Rochester

Salary:

19.62 - 26.49 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

High School Diploma required
Minimum of two years of relevant experience required, or an equivalent combination of education and experience
Medical Terminology, experiences with appointment scheduling software and electronic medical records preferred
Demonstrated customer relations skills required

Job Responsibility

Serves as the patient referral and prior authorization specialist, with oversight of data and compliance to enterprise standards and referral and prior authorization guidelines
Communicates regularly with patients, families, clinical and non-clinical staff, identifying barriers to appointment compliance, insurance company barriers, and tracking all assistance provided
Accountable for planning, execution, appeals, and efficient follow-through on all aspects of the process, which has a direct, multifaceted impact (quality, financial, patient satisfaction, etc.) on patient scheduling, treatment, care, and follow-up
Adheres to approved protocols for working referrals and prior authorizations
Makes decisions that are guided by protocols and practices requiring some interpretation
maintains an expert-level understanding of the department/division
May train new staff members

Fulltime

Medical Records and Authorization Specialist

As a member of the Baxter Finance team, you have the critical thinking and analy...

Location

United States , Houston

Salary:

49600.00 - 53000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
Associates degree or higher preferred
3+ years of industry experience in health insurance
Knowledge of Federal, State, and Local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations
Third party payer experience strongly preferred
Experience in reviewing medical records and obtaining third-party payer reimbursement
Exceptional written, verbal, and interpersonal communications
Strong critical thinking and problem-solving skills
Detail orientated and ability to multi-task
Ability to work independently as well as in a team environment

Job Responsibility

Perform Medical Records and Authorization Specialist duties including documentation collection and review, prior authorization and reauthorization submissions
Communicate directly with client medical records depts, patients, healthcare teams, sales teams, and insurance companies
Collaborate cross-functionally with other Cardiology Health teams
Ensure coverage and payer requirements
Gather clinical documentation to support medical necessity for Cardiology devices
Process paper and electronic correspondence, including logging and distribution of payer and patient inquiries
Establish and maintain positive partnerships with sales team and healthcare teams
Review and assess clinical documentation to ensure all applicable coverage criteria requirements are met
Prepare and submit prior authorization initial and renewal requests to all insurance companies
Process authorization decisions from payers timely to streamline and drive revenue

What we offer

Support for Parents
Continuing Education/ Professional Development
Employee Heath & Well-Being Benefits
Paid Time Off
2 Days a Year to Volunteer
Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP)
401(k) Retirement Savings Plan (RSP)
Flexible Spending Accounts

Fulltime

Medical Records and Authorization Specialist

As a member of the Baxter Finance team, you have the critical thinking and analy...

Location

United States , Houston

Salary:

49600.00 - 53000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
Associates degree or higher preferred
3+ years of industry experience in health insurance
Knowledge of Federal, State, and Local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations
Third party payer experience strongly preferred
Experience in reviewing medical records and obtaining third-party payer reimbursement
Exceptional written, verbal, and interpersonal communications
Strong critical thinking and problem-solving skills
Detail orientated and ability to multi-task
Ability to work independently as well as in a team environment

Job Responsibility

Perform Medical Records and Authorization Specialist duties including documentation collection and review, prior authorization and reauthorization submissions
Communicate directly with client medical records depts, patients, healthcare teams, sales teams, and insurance companies
Collaborate cross-functionally with other Cardiology Health teams
Ensure coverage and payer requirements
Gather clinical documentation to support medical necessity for Cardiology devices
Process paper and electronic correspondence, including logging and distribution of payer and patient inquiries
Establish and maintain positive partnerships with sales team and healthcare teams
Review and assess clinical documentation to ensure all applicable coverage criteria requirements are met
Prepare and submit prior authorization initial and renewal requests to all insurance companies
Process authorization decisions from payers timely to streamline and drive revenue

What we offer

Support for Parents
Continuing Education/ Professional Development
Employee Heath & Well-Being Benefits
Paid Time Off
2 Days a Year to Volunteer
Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP)
401(k) Retirement Savings Plan (RSP)
Flexible Spending Accounts

Fulltime

Medical Records and Authorization Specialist

As a member of the Baxter Finance team, you have the critical thinking and analy...

Location

United States , Houston

Salary:

49600.00 - 53000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
Associates degree or higher preferred
3+ years of industry experience in health insurance
Knowledge of Federal, State, and Local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations
Third party payer experience strongly preferred
Experience in reviewing medical records and obtaining third-party payer reimbursement
Exceptional written, verbal, and interpersonal communications
Strong critical thinking and problem-solving skills
Detail orientated and ability to multi-task
Ability to work independently as well as in a team environment

Job Responsibility

Perform Medical Records and Authorization Specialist duties including documentation collection and review, prior authorization and reauthorization submissions
Communicate directly with client medical records depts, patients, healthcare teams, sales teams, and insurance companies
Collaborate cross-functionally with other Cardiology Health teams
Ensure coverage and payer requirements
Gather clinical documentation to support medical necessity for Cardiology devices
Process paper and electronic correspondence, including logging and distribution of payer and patient inquiries
Establish and maintain positive partnerships with sales team and healthcare teams
Review and assess clinical documentation to ensure all applicable coverage criteria requirements are met
Prepare and submit prior authorization initial and renewal requests to all insurance companies
Process authorization decisions from payers timely to streamline and drive revenue

What we offer

Support for Parents
Continuing Education/ Professional Development
Employee Heath & Well-Being Benefits
Paid Time Off
2 Days a Year to Volunteer
Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP)
401(k) Retirement Savings Plan (RSP)
Flexible Spending Accounts

Fulltime

Field Reimbursement Specialist

Field Reimbursement Specialists (FRSs) are responsible for providing field suppo...

Location

United States

Salary:

88700.00 - 126940.00 USD / Year

Cencora

Expiration Date

Until further notice

Requirements

High School Diploma/GED required
Bachelor's degree or specific Practice Management experience preferred
Project management skills
Experience with extensive travel
Prior Authorization Certification Specialist (PACS) credentials from an industry approved licensing body, or obtain certification within the first six months of employment
Ability to conduct field-based reimbursement and access support, education, and consultation
Understands the dynamics of Specialty Pharmacy vs. Specialty Distribution
Broad understanding of the physician buy-and-bill model vs. assignment of benefits to alternate sites of care
Experience in revenue cycle, buy and bill (including billing with miscellaneous J-code), formulary, benefit investigations, prior authorization, coding, and appeals processes
Deep understanding of medical and pharmacy benefits/policies

Job Responsibility

Provide field support for patient access to client’s specified products through interaction with the client’s patient support program and provider customers
Provide expertise and advanced skills to resolve complex patient access and provider reimbursement issues
Provide educational services across a variety of healthcare provider sites of care
Work directly with the provider and their office support staff
Interact with other reimbursement and patient support services provided by clients
Plan and engage with customers, leveraging client approved resources, to educate on access and reimbursement topics
Manage daily activities that support appropriate patient access to our client’s products in the provider offices
Work as a liaison to other patient assistance and reimbursement support services offered by our clients
Travel weekly, which could include overnight, to healthcare offices within a designated territory
Educate provider office staff and practice managers on logistics needed to support client product

What we offer

Medical
dental
vision care
comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness
support for working families
backup dependent care
adoption assistance
infertility coverage
family building support
behavioral health solutions

Fulltime

Field Reimbursement Specialist

The Field Reimbursement Specialist (FRS) to serves as a subject-matter expert on...

Location

United States , Jersey City; Long Island; New York City; Brooklyn

Salary:

88700.00 - 126940.00 USD / Year

Cencora

Expiration Date

Until further notice

Requirements

Ability to conduct field-based reimbursement and access support, education, and consultation to key account customers and cross-functional partners
Understands the dynamics of specialty pharmacy
Experience in revenue cycle, formulary, benefit investigations, prior authorization, coding, and appeals processes
Deep understanding of pharmacy benefits/policies
Strong time management and planning skills
Proficient in Microsoft Word, Powerpoint, Excel, and Outlook
Live within a reasonable commuting distance of a major airport in the listed location and be able to travel within a territory that includes but may not be limited to New York City, NY, Brooklyn, NY, Queens, NY, and Long Island, NY
High School Diploma/GED required
Bachelor's degree or relevant practice management experience preferred
Previous experience as Field Reimbursement Manager/Specialist preferred

Job Responsibility

Educating providers and their office staff on access and reimbursement topics using client-approved resources
Supporting appropriate patient access to the client’s products by resolving reimbursement and coverage challenges
Collaborating with other patient assistance and reimbursement support services offered by the client
Educate provider office staff and practice managers on insurance issues relevant to the supported clients product, and inform the staff of important coverage and payer policy changes within assigned territories
Educate provider office staff with understanding the payers’ coverage management strategies for product, including coding, billing, formulary, prior authorization, and appeal processes
Probe to understand office processes and ability to discern root causes of access or reimbursement issues
Deliver interactive educational presentations at various provider sites of service
Provide information on relevant reimbursement topics related to our client’s products based on client’s approval
Performs other related duties as assigned

What we offer

Medical, dental, and vision care
Comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness
Support for working families, which may include backup dependent care, adoption assistance, infertility coverage, family building support, behavioral health solutions, paid parental leave, and paid caregiver leave
Variety of training programs, professional development resources, and opportunities to participate in mentorship programs, employee resource groups, volunteer activities

Fulltime

Prior Authorization Specialist

Robert Half

Location:
United States , Brea

Category:
Health and Beauty

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
March 26, 2026

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Job Posted:March 26, 2026

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