Prior Authorization Specialist

Zócalo Health

4h • Remote

About The Position

The Prior Authorization Specialist will join Zócalo Health during a period of rapid growth and increasing operational complexity. This role exists to help scale and execute a community-oriented primary care model that delivers measurable outcomes for high-need members and health plan partners. As a key member of our rapidly expanding team, you will drive the prior authorization process by managing timely, detailed correspondence with payers and healthcare providers to ensure strict adherence to guidelines. This role requires exceptional attention to detail in maintaining accurate, compliant, and up-to-date patient records.

Requirements

• High school diploma or equivalent required.
• 1 + year of prior authorization experience.
• Fluency in medical terminology and a solid understanding of major payer guidelines.
• Strong organizational skills with the ability to manage multiple priorities and high-volume workflows.
• Ability to maintain accuracy, confidentiality, and compliance with HIPAA requirements in a remote work environment.
• Strong written and verbal communication skills.
• Must be authorized to work in the United States.

Nice To Haves

• Direct experience with Medi-Cal Managed Care Plans
• Experience supporting Enhanced Care Management (ECM), Community Health Worker (CHW), and Community Support (CS) Services.
• Experience working with electronic health record and practice management systems, including Athena.
• Strong understanding of prior authorization workflows, including clinical review, coding accuracy, submission, denial management, appeals, and follow-up

Responsibilities

• Prepare and submit detailed pre-authorization requests to insurance payers, ensuring all required medical documentation, chart notes, CPT/ICD codes, and supporting documentation are accurate and submitted within required timelines.
• Act as the central point of coordination between healthcare providers, patients, internal operational teams, and insurance companies to track prior authorization status, clarify payer requirements, and resolve outstanding requests.
• Maintain accurate prior authorization records within Zocalo Electronic Medical Record, including approvals, denials, effective dates, units/visits, payer communications, and required follow-up actions.
• Research and assist in resolving prior authorization denials, missing information requests, payer discrepancies, and appeals in a timely manner.
• Collaborate closely with intake, clinical, billing, and payer operations teams to support timely authorization processing and reimbursement readiness.

Benefits

• Competitive salary: $25 per hour
• Equity compensation package
• Comprehensive benefits including medical, dental, and vision
• 401k
• Generous PTO policy (up to 15 days per year for FT employees)
• $1,000 home office stipend
• We provide the equipment needed for this role.
• Opportunity for rapid career progression with plenty of room for personal growth.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED