Patient Access & Prior Authorization Specialist

MML US Inc; San Diego (CA); On-site; USD 75,000 - 85,000; Full time

Job summary

Mainstay Medical is seeking a Prior Authorization Specialist to lead the PA process onsite in San Diego, coordinating with case management and reimbursement teams to secure timely access for patients. Strong knowledge of payer guidelines and medical necessity is essential.

This role emphasizes accuracy, persistence, and attention to detail, with a focus on reducing delays and denials while supporting physicians, patients, and field teams.

Qualifications

• Bachelor's degree or advanced degree with relevant experience; 2+ years in medical office, hospital, or payer with prior authorization.
• Knowledge of health insurance industry practices.
• Experience with Medicare, Medicaid, Tricare, Workers' Compensation, and Commercial Insurance.
• Excellent written and oral communication.
• Highly organized with attention to detail.
• Proficient in Microsoft Office and PowerPoint.
• Experience with Salesforce, Availity, eFax, and basic database tools.
• Problem-solver with ability to resolve challenges.
• Patient-centric, empathetic approach.

Responsibilities

• Own and manage the prior authorization process from submission to approval or denial.
• Submit accurate PA requests via payer portals.
• Collaborate with case management to align with payer policies.
• Maintain documentation and status updates in designated systems.
• Escalate complex or high-risk cases when needed.
• Identify process improvements and standardize resources.
• Ensure regulatory, privacy, and patient confidentiality compliance.

Skills

Communication

Attention to detail

Organizational skills

Problem solving

Empathy

Education

Bachelor's degree

Tools

Microsoft Office

Salesforce

Availity

eFax

Job description

Mainstay Medical is seeking a Prior Authorization Specialist to lead the PA process onsite in San Diego, coordinating with case management and reimbursement teams to secure timely access for patients. Strong knowledge of payer guidelines and medical necessity is essential.

This role emphasizes accuracy, persistence, and attention to detail, with a focus on reducing delays and denials while supporting physicians, patients, and field teams.