Insurance Authorization Coordinator I

AmeriPharma • Laguna Hills, CA

10d • $26 - $28 • Onsite

About The Position

The Insurance Authorization Coordinator I plays a critical role in the patient care continuum by conducting accurate, timely medical insurance verification and obtaining prior authorizations. The position works at the intersection of clinical care and revenue cycle management to support prompt access to specialty medications and home infusion therapies, protect the organization from financial risk, and facilitate reimbursement.

This role is fully on-site in Laguna Hills, California, with a Monday through Friday schedule from 8:00 a.m. to 5:30 p.m. The coordinator screens and prioritizes orders, verifies insurance profiles and coverage, submits and tracks authorizations, manages a caseload, and documents communications and account updates. The role also supports patients, providers, and internal teams, follows up on pending work, escalates unresolved issues, and complies with payer rules and company policies.

AmeriPharma describes itself as a rapidly growing healthcare company that values creativity, productivity, new ideas, and employees’ growth. Its mission is to achieve superior clinical and economic outcomes while providing compassionate patient care.

Requirements

• Associate’s degree.
• At least 2 years of experience in specialty pharmacy, home infusion, medical billing, and medical or pharmacy authorization processes.
• Experience as a medical coder or biller, with working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement.
• Knowledge of ICD-10, CPT, HCPC and J billing codes, medical terminology, CMS HCFA 1500 forms, and electronic billing.
• Knowledge of benefit investigation and patient responsibility agreements.
• Knowledge of automated billing systems.
• Advanced knowledge of Microsoft Word, Excel, and Outlook functions.
• Ability to read, write, speak, and understand English.
• Strong interpersonal skills and a service-oriented mindset.
• Ability to support colleagues in a fast-changing environment and collaborate across teams.
• Ability to use common-sense understanding, logical thinking, and data analysis to resolve abstract and concrete problems.
• Excellent time management, multitasking, and prioritization skills, including the ability to work independently with minimal guidance.
• High accuracy in typing and data entry.
• Flexibility to work the hours required to complete projects and daily duties in a timely manner.

Responsibilities

• Screen and prioritize orders that require benefits investigation and medical prior authorization.
• Review patient insurance profiles for completeness and verify insurance setup, plan types, and payer categories.
• Identify primary, secondary, tertiary, or supplemental coverage and the authorizing group.
• Generate and use reports to track monthly patient eligibility verifications.
• Identify and inform providers and patients about network providers and the organization’s network participation status.
• Submit prior authorization requests to medical plans and coordinate cases requiring clinical judgment with clinical staff.
• Generate reports on expiring medical authorizations and initiate reauthorization requests proactively.
• Maintain a full caseload while meeting or exceeding operational metrics and turnaround timeframes.
• Run pharmacy test claims and contact payers to verify member information.
• Document communications with insurance plans, including representative name, phone number, and call reference number.
• Accurately and promptly document medical authorization status updates on patient accounts.
• Answer inbound medical authorization calls and provide customer service to patients, doctors’ offices, and internal departments.
• Obtain and communicate necessary clinical information or medical records from providers to appeal denied or pending authorizations.
• Identify changes in patient medical plan coverage, update assigned orders, and coordinate new payer information with Billers.
• Create and use reminders and follow-up reports to complete pending or incomplete activities.
• Escalate unresolved benefits investigations and prior authorization issues to management after appropriate internal resolution attempts.
• Comply with payer rules, regulations, and company policies.
• Perform other tasks and duties as assigned by leadership.

Benefits

• Full benefits package including medical, dental, vision, and life coverage.
• Great pay and general compensation structures.
• Employee assistance program for mental health, legal questions, and financial counseling.
• Comprehensive PTO and sick leave options.
• 401(k) program.
• Opportunities for growth and advancement.
• Company-sponsored outings and team-building events.
• Casual Fridays.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree