Prior Authorization Specialist

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a dedicated Prior Authorization Specialist responsible for communicating with insurance providers to verify patient eligibility, confirming coverage and benefits, and securing required prior authorizations. The position requires managing and processing prior authorization requests, maintaining accurate records, and ensuring that patient demographic information is up-to-date for billing accuracy.

Key Responsibilities

• Communicates with insurance providers to verify patient eligibility, confirm coverage and benefits, and secure required prior authorizations.
• Manages and processes prior authorization requests submitted by clinics and Patient Care Coordinators.
• Accurately records and maintains detailed documentation of all findings and actions taken.
• Updates patient demographic information as needed to ensure accurate and complete billing statements.
• Consistently meets or exceeds established productivity and quality expectations for daily work output.
• Maintains accuracy levels in line with departmental error-rate standards.
• Provides training and guidance to internal staff on proper procedures for submitting, documenting, and processing prior authorization requests.

Qualifications

• 1+ years of Prior Authorization Experience
• 1+ years of Insurance Eligibility Experience
• High school diploma or GED
• Preferred: Healthcare Experience
• Preferred: Ophthalmology Experience

Skills

• Strong communication skills
• Detail-oriented with strong organizational skills
• Ability to meet productivity and accuracy expectations

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

* 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).


Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

* 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.