PRIOR AUTHORIZATION SPECIALIST - WFH in San Diego

NOW HIRING - Prior Authorization Specialist WFH in San Diego, CA

Are you a sharp, detail-oriented revenue cycle professional who thrives in a fast-paced environment? We are seeking a Prior Authorization Specialist to join a dynamic Revenue Cycle and Billing team supporting a global leader in medical technology and diagnostics. In this role, you will play a critical part in protecting revenue performance by ensuring the timely and accurate submission of prior authorizations for Category I molecular pathology testing. By bridging the gap between clinical documentation and complex insurance guidelines, you will directly prevent authorization-related denials and ensure that vital patient diagnostic care moves forward without delay.

Pay Rate: $25.00 / hour

Start Date: August 10, 2026

Location: WFH in San Diego, CA

What You'll Do Daily

• Submit and manage a high volume of prior authorizations (~75–100 per day) using payer portals, automated platforms, and internal systems.
• Review and interpret medical records, clinical documentation, and lab requisitions to ensure appropriate linkage between CPT codes (molecular) and ICD-10 diagnoses.
• Apply specific payer policies across Commercial, Medicare Advantage, and Medicaid lines of business.
• Monitor authorization statuses, complete proactive follow-up actions, resolve discrepancies with internal billing teams, and handle authorization-level appeals.
• Verify insurance eligibility, assign correct insurance to patient accounts, and update demographic information with data integrity.

What We Are Looking For

• 2–4 years of direct experience in prior authorization processing, laboratory billing, or healthcare revenue cycle management.
• Working knowledge of CPT coding (molecular pathology preferred), ICD-10 coding, and medical necessity guidelines.
• strong hands-on experience with Microsoft Excel, Word, and Outlook. Quick and accurate data entry skills (ten-key by touch). Experience with Salesforce, Glidian, or XIFIN is a huge plus!
• High school diploma required; some college coursework is preferred.

Skills That Will Make You Successful

• The ability to thrive and maintain accuracy in a high-volume, production-driven environment.
• strong critical thinking skills to interpret complex payer policies and clinical data.
• Excellent communication skills with a cooperative, respectful, and highly professional team attitude.
• A reliable self-starter who works well independently and easily adapts to changing business demands.

TO APPLY: Email Resume to: claudia.mendoza@randstadusa.com

If this job is not for you, feel free to refer a friend.

Skills

• Prior Authorization
• Billing Specialist
• Medical Billing
• Revenue Cycle
• Reimbursement Specialist
• Referral Coordinator
• lab billing
• billing
• Appeals
• denials
• Eligibility
• Medicare
• Medicaid

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.