{"id":3418512,"url":"https://alion.io/job/ameripharma-insurance-authorization-coordinator-i","title":"Insurance Authorization Coordinator I","company":{"id":668851,"name":"AmeriPharma","domain":"ameripharma.com","url":"https://alion.io/company/ameripharma","size_band":"51-200","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"BambooHR","truth_index":{"grade":"A","score":95,"open_postings":14,"ghost_share":0,"stale_share":0,"repost_share":0,"time_to_fill_p50_days":119,"computed_at":"2026-11-09T06:03:00Z"}},"role":"Administrative","role_family":"Administrative","seniority":"junior","employment_type":"full_time","work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Laguna Hills, United States"],"countries":["US"],"hiring_countries":[],"hiring_countries_total":0,"salary":null,"salary_estimate":{"min_usd":34000,"max_usd":74000,"period":"year","method":"role_country_seniority_unknown","sample_n":11684},"experience_years_min":2,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Outlook","optional":false}],"status":"live","first_seen_at":"2026-10-28T20:16:51Z","employer_posted_date":"2026-10-28","last_verified_at":"2026-11-09T23:45:07Z","board_verified":true,"closed_at":null,"days_open":12,"trust":{"level":"ok","repost_count":0,"flags":[],"days_open":11},"description":"About AmeriPharma\nAmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.\nAmeriPharma’s Benefits\nFull benefits package including medical, dental, vision, life that fits your lifestyle and goals\nGreat pay and general compensation structures\nEmployee assistance program to assist with mental health, legal questions, financial counseling etc.\nComprehensive PTO and sick leave options\n401k program\nPlenty of opportunities for growth and advancement\nCompany sponsored outings and team-building events\nCasual Fridays\nJob Summary\nPrior Authorization Coordinator I plays a critical role in the patient care continuum by executing accurate, timely medical insurance verification and securing essential prior authorizations. Operating at the intersection of clinical care and revenue cycle management, this position ensures patients receive prompt access to life-altering specialty medications and home infusion therapies while safeguarding the organization against financial risk and enabling seamless reimbursement.\nSchedule Details\nLocation: Fully On-Site, Laguna Hills, CA\nSchedule: Monday - Friday 8:00AM-5:30PM\nDuties & Responsibilities\nIntake, Screening & Insurance Verification\nOrder Triaging: Screen and prioritize orders requiring benefits investigation and medical prior authorization.\nProfile Review: Review the completeness of payers documented in each patient’s insurance profile, verifying accuracy of insurance setup, plan types, and payer categories.\nCoordination of Coverage: Identify patient’s primary, secondary, tertiary, or supplemental plans alongside the authorizing group.\nEligibility Tracking: Generate and utilize reports to track ongoing monthly patient eligibility verifications.\nNetwork Status Guidance: Identify and inform providers and patients regarding network providers and the organization's network participation status.\nPrior Authorization & Case Management\nPA Submission: Submit prior authorization requests to medical plans and coordinate the review of cases requiring clinical judgment with clinical staff.\nReauthorizations: Generate expiring medical authorization reports and proactively initiate reauthorization requests to ensure continuity of care without delay.\nCaseload Management: Maintain a full caseload while meeting or exceeding designated operational metrics and turnaround timeframes.\nPharmacy Support: Run pharmacy test claims and contact payers to verify member\nCommunication & Documentation\nPayer Correspondence: Document all communications with insurance plans, including the representative's name, phone number, and call reference number.\nAccount Updating: Document detailed medical authorization status updates on patient accounts accurately and promptly.\nProvider & Patient Liaison: Answer inbound medical authorization calls, providing high-level customer service to patients, doctors' offices, and internal departments.\nClinical Info Retrieval: Obtain and communicate necessary clinical information or medical records directly with providers to appeal denied or pending authorizations.\nCoverage Shifts: Identify changes in patient medical plan coverage, update assigned orders, and coordinate new payer information with Billers to ensure accurate claim submission.\nCompliance & Performance Tracking\nTask Follow-up: Create and utilize reminders and follow-up reports to ensure completion of all pending or incomplete activities.\nManagement Escalation: Escalate unresolved benefits investigations and prior authorization issues to management after proper internal resolution attempts have been made.\nRegulatory Alignment: Ensure strict compliance with all payer rules, regulations, and company policies.\nOther Duties: Perform alternative tasks and duties as assigned by leadership.\nRequired Skills\nCommunication: Ability to read, write, speak, and understand the English language. Strong interpersonal skills with a service-oriented mindset.\nCollaboration: Ability to support colleagues in a fast-changing environment and cooperate across teams for all pharmacy needs.\nCritical Thinking: Ability to apply common sense understanding, logical thinking, and data analysis to resolve abstract and concrete problems.\nWork Management: Excellent time management, multi-tasking, and prioritization skills with the ability to work independently under minimal guidance.\nTechnical Aptitude: High accuracy in typing and data entry.\nFlexibility: Ability to work the hours required to ensure all projects and daily duties are completed in a timely manner.\nRequired Qualifications\nAssociate’s Degree \nAt least 2 years of experience in specialty pharmacy, home infusion, medical billing, and medical/pharmacy authorization processes.\nExperienced as a medical coder/biller with a working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement. \nKnowledge of ICD 10, CPT, HCPC and J billing codes and medical terminology, with CMS HCFA 1500 form & Electronic Billing. Knowledge of Benefit Investigation and Patient Responsibility Agreements. \nKnowledge of automated billing systems. Advanced knowledge of Word, Excel, and Outlook functions.\nAmeriPharma’s Mission Statement\nOur goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care!\nPhysical Requirements\nThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 20 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus.\nEEO Statement\nThe above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. 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