Acute Care Prior Authorization Pro

California Specialty Pharmacy,LLC; California (MO); On-site; USD 52,000 - 78,000; Full time

Job summary

California Specialty Pharmacy, LLC is seeking an Acute Prior Authorization Specialist to ensure timely and accurate approvals for acute medical services. You will review clinical documentation, verify benefits, and navigate payer requirements to expedite care while ensuring compliance.

The role collaborates with healthcare providers, insurers, and patients to reduce delays in acute care, maintain records, and support clinical and administrative teams.

Qualifications

• Minimum 1–2 years in prior authorization, medical billing, or healthcare administration.
• Strong knowledge of insurance plans and reimbursement processes.
• Proficiency with electronic health records (EHR) and prior authorization tools.
• Excellent communication skills, written and verbal, with diverse stakeholders.

Responsibilities

• Review and process prior authorization requests for acute medical services per payer guidelines.
• Request and clarify clinical documentation from providers as needed.
• Verify patient insurance coverage and benefits to determine authorization requirements.
• Collaborate with insurers to resolve denials, appeals, and inquiries.

Skills

Prior Authorization

Healthcare Administration

EHR Proficiency

Education

High school diploma

Tools

EHR Systems

Prior Authorization Software

Job description

California Specialty Pharmacy, LLC is seeking an Acute Prior Authorization Specialist to ensure timely and accurate approvals for acute medical services. You will review clinical documentation, verify benefits, and navigate payer requirements to expedite care while ensuring compliance.

The role collaborates with healthcare providers, insurers, and patients to reduce delays in acute care, maintain records, and support clinical and administrative teams.