Prior Authorizations Coordinator

TPIRC and FAI•Long Beach, CA

3d•Onsite

About The Position

We are currently seeking a Prior Authorization Specialist who will be responsible for reviewing and processing prior authorization requests for medical services, procedures, labs, and prescriptions. This role ensures that patients receive necessary treatments in accordance with their insurance coverage, while also managing communication with healthcare providers, insurance companies, and patients to verify benefits and eligibility. Founded in 2015, the Food Allergy Institute (FAI) is a cutting-edge research and clinical care center revolutionizing food allergy treatment. Our Tolerance Induction Program™ is the first of its kind, bringing patients to the point where they can eat whatever they want, whenever they want, without having to worry about any kind of reaction. The success of FAI is built on years of development involving proprietary biomarkers, data analytics and modeling systems which allow unique patient specific therapy to be deployed in the clinic setting and at home safely. The Food Allergy Institute (FAI) is home to innovative thinkers, problem solvers, and passionate leaders who are transforming the world of food allergy treatment. Our work is life-changing for patients and their families, and every member of our team plays a vital role in supporting our mission. With over 180 employees, Our diverse team includes Physicians in the specialties of Pediatrics, Pulmonary, Allergy & Immunology, Emergency Medicine, as well as Nurse Practitioners, Physicians Assistants, and a PhD level research team. In the food allergy world, the growth of FAI is unique in reflecting the effectiveness of its treatment approach and the supportive environment fostered by its team of professionals. At FAI, you'll be part of a team dedicated to making a real impact. We provide access to cutting-edge technology, offer competitive salaries, comprehensive benefits, and endless opportunities for professional development and career growth. Join us in transforming food allergy care and be inspired to make a difference.

Requirements

High school diploma or equivalent required; completion of medical billing and coding or Medical Assistant program preferred.
At least 2-3 years of experience as a Medical Assistant or with prior authorizations.
Knowledge of medical terminology and insurance processes.
Experience with medical billing systems and electronic health records (EHR).
Highly organized with strong attention to detail and follow-up.
Team Mentality and a positive working attitude.
Strong verbal and written communication skills.
Excellent interpersonal and customer service skills.
Excellent time management skills and self-starter mentality.
Ability to work in a fast-paced environment that requires strong multi-tasking skills

Responsibilities

Review and submit prior authorization requests for medical services, procedures, labs and medications to insurance companies or third-party payers.
Verify patient insurance coverage, eligibility, and plan limitations to determine the necessity of prior authorization.
Communicate with healthcare providers (physicians, providers, nurses, etc.) to gather required documentation, such as medical histories and prescriptions.
Submit claims and follow up with insurance companies for approvals, denials, or further information requests.
Address any denied claims by working with healthcare providers to submit appeals or adjust the requested services or medications.
Inform patients about the status of their prior authorization requests, insurance coverage, and potential out-of-pocket costs.
Maintain accurate and detailed records of all authorization requests, approvals, denials, and communications in the medical management system.
Work closely with clinical staff, billing departments, and other administrative teams to ensure a smooth and timely prior authorization process.
Look for areas of opportunity and communicate these to leadership.
Ensure compliance with federal, state, and payer regulations regarding prior authorizations and insurance claims.
Complete all other duties as assigned.