Job Description

Level: Experienced
Job Location: 6125 Paseo Del Norte Ste 130 - Carlsbad, CA 92011
Position Type: Full Time
Salary Range: $23.00 - $28.00 Hourly

We are seeking an experienced and detail-oriented Prior Authorization Specialist to join our growing team. The ideal candidate will have extensive knowledge of insurance authorization processes across multiple specialties and the ability to manage high-volume requests for several clinic locations.
This role requires a proactive professional who can work independently, communicate effectively with providers and insurance carriers, and ensure timely approvals to support quality patient care.
Responsibilities
- Submit and track prior authorization requests for:
- - GI procedures
- - Pain management services
- - Imaging studies
- - Urology and cardiology services as needed
- Verify insurance eligibility and benefits
- Obtain and document authorizations accurately and efficiently
- Follow up with insurance companies regarding pending, delayed, or denied requests
- Coordinate with physicians, clinical staff, and scheduling teams across multiple locations
- Maintain accurate documentation within the EMR system
- Ensure compliance with payer guidelines and company policies
- Assist with appeals, reconsiderations, and peer-to-peer coordination when necessary
- Prioritize urgent requests while maintaining high accuracy standards
- Utilize insurance and imaging/pre-certification portals to process and manage authorizations, including platforms such as Availity, RadMD, eviCore, Carelon/AIM, and other payer-specific portals

Qualifications
- Minimum 3+ years of prior authorization experience in a medical setting
- Experience handling multiple specialties required
- Strong understanding of commercial insurance, Medicare, Medi-Cal, and managed care plans
- Knowledge of GI, pain management, imaging, urology, and cardiology authorizations preferred
- Familiarity with imaging and pre-certification insurance portals such as Availity, RadMD, eviCore, AIM/Carelon, and payer-specific portals
- Ability to manage authorizations for multiple clinic locations simultaneously
- Excellent organizational and time-management skills
- Strong verbal and written communication skills
- EMR/EHR experience required
- Ability to work independently and in a fast-paced environment