Medical Authorization Specialist

The Authorization Support Specialist plays a critical role in supporting the Prior Authorization (PA) workflow by ensuring timely follow-up, accurate documentation, and effective communication with insurance payers and internal teams. This position is primarily responsible for contacting insurance companies to obtain status updates on submitted prior authorizations, entering approval and denial documentation into the electronic health record (EHR) system, and reviewing denial outcomes prior to escalation to the specialized clinical review team. The Authorization Support Specialist helps ensure continuity of care, reduces authorization delays, and supports compliance with payer and operational requirements.
Essential Duties and Responsibilities
Other duties may be assigned as necessary.

• Prior Authorization Status Follow-Up: Proactively contact insurance companies via phone, portals, or fax to obtain real-time status updates on submitted prior authorization requests.
• Documentation & Data Entry: Accurately enter PA approval letters, authorization numbers, effective dates, and related documentation into the organization's billing and healthcare software systems.
• Denial Review & Routing: Review PA denial letters for completeness and clarity, ensuring all required documentation is captured before forwarding cases to the clinical review team for appeal determination.
• Queue & Workflow Management: Monitor assigned PA work queues to ensure timely follow-up and prevent delays in patient therapy initiation or continuation.
• Payer Communication & Tracking: Maintain detailed notes of payer interactions, including call outcomes, reference numbers, and next steps, in accordance with internal documentation standards.
• Collaboration with Internal Teams: Communicate authorization outcomes and issues with pharmacy operations, clinical, and billing/revenue cycle teams to support coordinated patient care.
• Compliance & Accuracy: Ensure all authorization activities comply with payer requirements, internal policies, and regulatory standards.
• Continuous Improvement Support: Identify recurring payer issues, trends in denials, or process inefficiencies and escalate insights to leadership as appropriate.

Qualification Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Detail Orientation: High level of accuracy in data entry and the ability to identify specific details within complex insurance documents.
• Communication Skills: Strong verbal communication skills for professional interaction with insurance representatives and internal staff.
• Technical Proficiency: Ability to navigate complex healthcare software systems and insurance portals; experience with industry-standard EHR/billing software is a significant advantage.
• Time Management: Ability to manage a high volume of pending authorizations and prioritize follow-ups based on urgency and patient need.

Education and/or Experience

• Educational Background: A High School Diploma or equivalent is required.
• Experience: A minimum of 1-2 years of experience in healthcare administrative support, billing, or medical insurance verification.
• Technical Experience: Previous experience working with Prior Authorizations (PA) and familiarity with medical terminology or pharmacy workflow is highly preferred.
• Schedule: Monday - Friday 8:30 am to 5 pm fully onsite

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.