Prior Authorization Coordinator
About The Position
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
- High School diploma or equivalent required.
- 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.
- 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.
- 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.
Nice To Haves
- Medical Assistant diploma or Associate’s degree in healthcare administration, business administration, or related field 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.
Responsibilities
- Facilitate the administrative components of the prior authorization process.
- Ensure accurate data entry, eligibility verification, and documentation management.
- Coordinate between providers, health plans, and clinical staff.
- Prepare authorization requests for clinical review.
- Ensure completeness of documentation.
- Assist in maintaining compliance with regulatory, health plan, and organizational requirements.
- Support timely and accurate authorization processing.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
