Prior Authorization Specialist

Duties & Responsibilities

• Submit prior authorization requests accurately and within established timeframes through the EMR system while adhering to payer-specific and state regulatory requirements.
• Collaborate with clinic front desk staff to ensure all required documentation is complete, accurate, and uploaded to support authorization submissions.
• Provide ongoing feedback to front desk personnel and Authorization & Verification (A&V) vendors regarding opportunities to improve authorization workflows, verification processes, and turnaround times.
• Serve as a resource for authorization and insurance verification inquiries from clinic staff and external vendors, ensuring timely issue resolution.
• Investigate and resolve authorization- and verification-related denials promptly, while identifying root causes and providing recommendations to prevent future denials.
• Complete eligibility and benefits verification for same-day and walk-in patients by contacting insurance carriers via phone, fax, or online portals to confirm coverage, authorization requirements, and outpatient therapy benefits.
• Obtain, track, and secure authorizations for Workers' Compensation cases throughout the patient's course of treatment, ensuring uninterrupted coverage and reimbursement.
• Conduct bi-monthly batch eligibility reviews and coordinate with clinic staff to address accounts identified as ineligible or requiring additional follow-up.
• Support onboarding and ongoing education efforts by assisting with training for new Authorization & Verification team members and reinforcing best practices for existing staff.
• Foster positive working relationships with internal teams and external vendors to resolve issues, enhance knowledge of payer requirements, and promote standardized operational processes.
• Utilize EMR and business intelligence reporting tools to monitor authorization status, benefit utilization, missing approvals, and other key performance indicators as directed by leadership.
• Perform additional responsibilities and special projects as assigned to support departmental and organizational objectives.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).


* As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.