Prior Authorization Specialist

6 days ago


Los Angeles, California, United States Regal Medical Group Full time

We are seeking a Prior Authorization Specialist to join our team at Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County.

Job Summary:

The Prior Authorization Specialist will be responsible for providing efficient and accurate information to prior authorization requests, ensuring correct benefits, co-pays, and financial responsibility are provided to requestors.

Key Responsibilities:

  • Anticipate customer needs by understanding the process and job guidelines to provide accurate and timely information to the Prior Auth department.
  • Data entry via GCEA/REA
  • Verify eligibility and benefits on all requests from Prior Authorization.
  • Verify financial responsibility for all requests.
  • Maintain turnaround time compliance in all aspects of the UM process.
  • Maintain all reference material provided by supervisors, managers, or directors.
  • Know and follow Employee Handbook policies and procedures.
  • Maintain patient confidentiality to ensure HIPAA compliance at all times.
  • Demonstrate honesty and integrity in everyday activities.
  • Recognize errors and immediately report to appropriate management.
  • Maintain regulatory turn-around Time Standards per CMS (Seniors) and ICE (Commercial).
  • Assist other staff and support the team approach.
  • Participate in the efficient, effective, and responsible use of resources such as supplies and equipment.
  • Communicate effectively and clearly with management and coworkers.
  • Perform other duties as directed by management.

Requirements:

  • 2-4 years of experience with HMO referrals and prior authorizations.
  • Knowledge of Healthcare and Managed Care preferred.
  • Typing 40 words per minute with accuracy.
  • Knowledge of computers, faxes, printers, and all other equipment.
  • Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and Power Point).
  • Ability to multi-task and meet deadlines.

About Our Company:

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County offers a fast-paced, exciting, welcoming, and supportive work environment. We promote teamwork, nurture learning, and encourage advancement for all employees.

Estimated Salary Range:

$23 - $28 per hour, depending on individual factors, including market location, job-related knowledge, licensure, skills, and experience.

Benefits Package:

  • Employer-paid comprehensive medical, pharmacy, and dental for employees
  • Vision insurance
  • Zero co-payments for employed physician office visits
  • Flexible Spending Account (FSA)
  • Employer-Paid Life Insurance
  • Employee Assistance Program (EAP)
  • Behavioral Health Services

Other Benefits:

  • Vacation Time
  • Company celebrations
  • Employee Assistance Program
  • Employee Referral Bonus
  • Tuition Reimbursement
  • License Renewal CEU Cost Reimbursement Program
  • Business-casual working environment
  • Sick days
  • Paid holidays
  • Mileage

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