Zócalo Health
Healthcare
PriorAuthorizationSpecialist
“Prior Authorization Specialist at Zócalo Health. Skills: Prior authorization, Payer coordination, Record keeping. Prepare and submit pre-authorization requests. Ensure medical documentation accuracy”
Industry & Context.
What They're Looking For.
Must Have
High school diploma or equivalent, 1+ year prior authorization experience, Fluency in medical terminology, Understanding of major payer guidelines, Ability to maintain accuracy, confidentiality, and compliance with HIPAA
Nice to Have
Direct experience with Medi-Cal Managed Care Plans, Experience supporting Enhanced Care Management (ECM), Community Health Worker (CHW), and Community Support (CS) Services, Experience with electronic health record and practice management systems, Experience with Athena, Understanding of prior authorization workflows
What You'll Do.
Prepare and submit pre-authorization requests
Ensure medical documentation accuracy
Track prior authorization status
Clarify payer requirements
Resolve outstanding requests
Maintain accurate prior authorization records
Research prior authorization denials
Assist in resolving payer discrepancies
Collaborate with intake teams
Collaborate with clinical teams
Collaborate with billing teams
Collaborate with payer operations teams
How You'll Work.
Team & Collaboration
Internal operational teams; Healthcare providers; Insurance companies; Intake teams; Clinical teams; Billing teams; Payer operations teams
Communication Scope
Written communication; Verbal communication
Applying for this Prior Authorization Specialist role?
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