Prior Authorization Coordinator

Socket.dev; San Bernardino (CA); On-site; USD 36,000 - 40,000; Full time

Job summary

Socket.dev is hiring a Prior Authorization Coordinator to support the Utilization Management department by managing the administrative elements of prior authorization. You will ensure accurate data entry, verify eligibility, manage documentation, and coordinate with providers, health plans, and clinical staff.

The role involves preparing authorization requests, maintaining documentation completeness, and helping ensure regulatory compliance within an MSO to promote timely, quality care delivery.

Qualifications

• High School diploma or equivalent required.
• Medical Assistant diploma or related degree preferred.
• 1+ year healthcare admin experience in MSO/IPA/health plan environments preferred.
• Knowledge of CPT/ICD-10/HCPCS codes is a plus.

Responsibilities

• Enter and verify data accurately for prior authorization requests.
• Coordinate with providers, health plans, and clinical staff.
• Prepare authorization requests for clinical review and ensure documentation completeness.
• Support regulatory, health plan, and organizational compliance in the authorization process.

Skills

Data entry

Time management

MS Office

EMR systems

Professional communication

Documentation accuracy

Education

High School diploma or equivalent

Medical Assistant diploma / Associate’s degree (preferred)

Tools

Microsoft Office

EMR software

Authorization platforms

Job description

Description

JOB SUMMARY

The Prior Authorization Coordinator is responsible for supporting the Utilization Management department by facilitating the administrative components of the prior authorization process. This role ensures accurate data entry, eligibility verification, documentation management, and coordination between providers, health plans, and clinical staff. The Coordinator prepares authorization requests for clinical review, ensures completeness of documentation, and assists in maintaining compliance with regulatory, health plan, and organizational requirements. This position plays a critical role in supporting timely and accurate authorization processing to promote continuity of care and efficient utilization of healthcare services within a Managed Services Organization (MSO).

Requirements

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training

Minimum: High School diploma or equivalent required.

Preferred: Medical Assistant diploma or Associate’s degree in healthcare administration, business administration, or related field preferred.

Experience

Minimum: At least one year of administrative experience in a healthcare, medical office, MSO, IPA, or health plan environment. Basic knowledge of medical office procedures and managed care processes.

Preferred: Experience working in Utilization Management, Prior Authorization, Referral Management, or Medical Management within an MSO, IPA, medical group, or health plan. Knowledge of medical terminology. Experience with electronic medical records, utilization management systems, or authorization platforms. Familiarity with CPT, ICD-10, and HCPCS codes preferred. Experience supporting Medi-Cal, Medicare, or commercial managed care plans preferred.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Skills, Knowledge & Abilities

• Strong data entry skills with attention to detail and accuracy.
• Ability to manage multiple tasks and prioritize workload efficiently.
• Proficiency in Microsoft Office applications (Word, Excel, Outlook).
• Ability to learn and use electronic medical record and authorization systems.
• Strong verbal and written communication skills.
• Ability to communicate professionally with providers, health plans, and internal staff.
• Strong customer service skills with a service-oriented approach.
• Ability to review documentation for completeness and accuracy.
• Strong organizational and time management skills.
• Ability to work in a fast-paced, deadline-driven environment.
• Ability to maintain confidentiality and protect sensitive health information.
• Ability to work independently and collaboratively as part of a team.
• Strong attention to detail and commitment to quality.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical demands described here are represented of those that must be met by an employee to successfully perform the essential functions of this job. Prolonged sitting, typing, and computer use. Occasional standing, walking, bending, and reaching. Ability to lift up to 20 pounds occasionally. Ability to concentrate and review detailed information for extended periods. Ability to manage multiple priorities and meet deadlines. Ability to perform repetitive tasks with a high degree of accuracy. Office-based work environment within an MSO or medical management setting. Frequent interaction with internal staff, providers, and health plans via phone and electronic communication. Low to moderate noise level typical of an office environment.

PAY RANGE

$26.00 - $29.00 / hourly