Prior Authorization Specialist Job at Robert Half (Brea)

Prior Authorization Specialist

We are looking for a Prior Authorization Specialist to support front-end revenue...

Location

United States , Chandler

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent is required
At least 6 months of experience handling prior authorization activities in a healthcare setting
Background in front-end healthcare revenue cycle operations, including insurance verification and benefits review
Working knowledge of pharmacy benefits, medication-related coverage considerations, and patient financial estimates
Familiarity with commercial insurance, Medicare, and Medicaid plans and their authorization requirements
Ability to interpret medical terminology, clinical services, and procedural information accurately
Experience using EMR or EHR platforms
Epic experience is required
Proven ability to work effectively in a high-volume, productivity-focused remote environment

Job Responsibility

Evaluate scheduled patient services and coverage details to determine when pre-service authorization or other financial clearance steps are required
Obtain initial approvals and follow-up authorizations within required timeframes to prevent delays in care or claim issues
Verify insurance eligibility, review benefit information, and interpret payer guidelines to support accurate account clearance
Calculate and communicate patient financial responsibility estimates based on plan coverage, benefits, and service details
Document authorization activity, verification findings, and account updates within EMR or EHR systems, preferably Epic
Work across assigned specialty areas such as cardiology, imaging, surgery, or other service lines based on business needs
Participate in daily remote team huddles and maintain productivity standards in a fast-paced, metrics-driven environment
Provide guidance to newer team members when needed on payer requirements, workflow expectations, and revenue cycle-related issues
Support additional work assignments related to financial clearance, insurance review, and pre-service account readiness as needed

What we offer

medical
vision
dental
life and disability insurance
401(k) plan
free online training

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

Insurance Authorization Specialist

We are seeking a detail-oriented Insurance Authorization Specialist to support t...

Location

United States , Indianapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
associate degree preferred
1+ years of experience in insurance authorization, medical billing, healthcare administration, or a related role preferred
Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans
Familiarity with prior authorization and eligibility verification processes
Experience with electronic health records and insurance portals
Strong attention to detail and organizational skills
Excellent verbal and written communication skills
Ability to manage deadlines and work independently in a high-volume environment

Job Responsibility

Verify insurance eligibility, benefits, and coverage details
Obtain prior authorizations and pre-certifications for services, procedures, and medications
Communicate with insurance carriers, providers, patients, and internal teams regarding authorization requirements and status updates
Review documentation for completeness and accuracy before submission
Track authorization requests, approvals, denials, and expirations
Follow up on pending and denied authorizations and escalate issues as needed
Maintain accurate records in billing, practice management, or electronic health record systems
Ensure compliance with payer guidelines, healthcare regulations, and company policies
Assist with appeals and supporting documentation for denied requests
Collaborate with clinical, billing, and administrative teams to reduce delays in service and reimbursement

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

Insurance Authorization Specialist

We are seeking a detail-oriented Insurance Authorization Specialist to support t...

Location

United States , Indianapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
associate degree preferred
1+ years of experience in insurance authorization, medical billing, healthcare administration, or a related role preferred
Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans
Familiarity with prior authorization and eligibility verification processes
Experience with electronic health records and insurance portals
Strong attention to detail and organizational skills
Excellent verbal and written communication skills
Ability to manage deadlines and work independently in a high-volume environment

Job Responsibility

Verify insurance eligibility, benefits, and coverage details
Obtain prior authorizations and pre-certifications for services, procedures, and medications
Communicate with insurance carriers, providers, patients, and internal teams regarding authorization requirements and status updates
Review documentation for completeness and accuracy before submission
Track authorization requests, approvals, denials, and expirations
Follow up on pending and denied authorizations and escalate issues as needed
Maintain accurate records in billing, practice management, or electronic health record systems
Ensure compliance with payer guidelines, healthcare regulations, and company policies
Assist with appeals and supporting documentation for denied requests
Collaborate with clinical, billing, and administrative teams to reduce delays in service and reimbursement

What we offer

Medical
Vision
Dental
Life and disability insurance
401(k) plan
Free online training

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

Authorization And Referral Support Specialist

We are seeking a compassionate, detail-oriented Authorization & Referral Support...

Location

United States , Las Vegas

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience in referrals, authorizations, or medical administrative support preferred
Familiarity with medical terminology or healthcare processes
Strong phone etiquette and communication skills
Compassionate, patient-focused approach
Highly organized with the ability to multitask efficiently
Open to early-career candidates (if hold familiarity with medical terminology)
Bilingual preferred but not required

Job Responsibility

Follow up on patient referrals to confirm appointments are scheduled and completed
Contact families and providers regarding referral status and next steps
Manage inbound voicemails and respond to referral-related emails
Assist with clerical and administrative tasks for the authorization/referral team
Utilize internal systems to track referral activity and maintain accurate records
Support coordination of care by ensuring timely communication between patients, families, and providers
Monitor and manage incoming communications to the department

What we offer

Medical, vision, dental, and life and disability insurance
401(k) plan
Free online training
Access to top jobs
Competitive compensation

Infusion Systems Sales Specialist

As a member of Baxter's sales team, you'll be aligned to one of our global busin...

Location

United States , San Diego

Salary:

88000.00 - 121000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

Bachelor's degree with 3+ years of experience or 6+ years of experience with a high school diploma or GED
Prior Capital equipment sales experience is a plus
Knowledge of IV Therapy and related products is a plus
Strong interpersonal and communication skills which includes both written and oral, as well as negotiation and presentation skills
The ability to analyze and interpret data for effective sales targeting strategies
Travel is required and may involve visits to remote or urban areas either individually or with other personnel
Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment visa at this time.

Job Responsibility

Achieving sales quotas through the direct sale of the company's products or services. Implementing sales strategies to attain sales volume, product mix and profit objectives
Calling on prospective customers, delivering effective sales presentations, providing technical and administrative product information and/or demonstrations, and quoting appropriate customer prices
Monitoring sales against forecasts and participating in the determination of market potential for the territory
Working closely with customer service and operations to ensure high levels of customer satisfaction
Providing feedback to immediate supervisor and marketing personnel for the development of marketing policy, recommended product and product line revisions as well as pricing changes
Promoting the Baxter Culture through positive ongoing relationships and activities

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

Admissions Services Specialist

Acadia Healthcare is seeking remote Admissions Services Specialists to support o...

Location

United States , Franklin

Salary:

Not provided

Acadia Healthcare

Expiration Date

Until further notice

Requirements

Bachelor's or Master's degree in Behavioral Science, Social Work, Sociology, Nursing, or a related field
in some states, RN, LVN/LPN
Knowledge of admission/referral processes, techniques, and tools
Familiarity with behavioral health issues and services
Solid understanding of financial principles and insurance reimbursement practices
Knowledge and proficiency with Salesforce.com (or other CRM application), Concur, and MS Office application
Licensure, as required for the area of clinical specialty, i.e., RN license, CAC or other clinical counseling or therapy license, as designated by the state in which the facility operates

Job Responsibility

Manage Referral Management Portals
Monitor all faxed referrals
Monitor all webforms and call center handoffs/rollover referrals
Utilize facility admissions/exclusionary criteria to process incoming types of referrals
Respond to inquiries about the facility within facility policy timeframes
Document calls inside of Salesforce and follow-up as needed
Complete Prior Authorization
Pre-Admit the patients in billing system
Coordinate with local admissions department regarding bed availability
Facilitate intake, admissions, and utilization review process for incoming patients

Fulltime

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Prior Authorization Specialist

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