Eligibility & Prior Authorization Specialist

Company: Alcam Medical Orthotics and Prosthetics Alcam Medical is a Riverside, CA-based orthotics and prosthetics (O&P) provider. We fit and deliver custom orthotic and prosthetic devices to patients across Southern California, working with commercial payers, Medi-Cal managed care plans, and Medicare. Getting devices to patients quickly depends on clean, fast eligibility checks and authorizations — that's where you come in. The Role We need a detail-oriented specialist who lives inside health plan portals and isn't afraid to get on the phone. You'll verify patient eligibility, identify the correct payer of record, and manage the full authorization lifecycle — from initial requests to updates — for O&P claims. What You'll Do ▪️ Eligibility verification: Check patient eligibility and benefits through health plan portals (Availity, payer-specific portals, Medi-Cal/Medicare portals, etc.) before service delivery ▪️ Payer identification: Call health plans directly to confirm coordination of benefits and determine which payer is at risk/primary for a given claim ▪️ Authorization management: Submit new prior authorization requests and update/extend existing authorizations as treatment plans change ▪️ Documentation retrieval: Call physician offices to request and collect clinical documentation (chart notes, prescriptions, letters of medical necessity) needed to support authorization requests ▪️ Follow-up: Track pending authorizations, follow up on denials or requests for additional information, and escalate stalled cases ▪️ Recordkeeping: Log all eligibility and authorization activity accurately in our systems so the clinical and billing teams always know claim status What You Need ▪️ 2+ years of experience in orthotics/prosthetics or medical billing/authorizations (healthcare RCM experience required) ▪️ Hands-on experience navigating health plan web portals (Availity, payer portals, Medi-Cal/managed care portals) ▪️ Comfortable and confident making outbound calls to health plans and physician offices — this is a significant part of the role ▪️ Working knowledge of eligibility verification, coordination of benefits, and the prior authorization process ▪️ Familiarity with CPT/HCPCS codes relevant to O&P a plus ▪️ Excellent written English and phone communication skills ▪️ Highly organized — able to manage a queue of active authorization cases without dropping follow-ups ▪️ Reliable internet connection and a quiet environment for calls Nice to Have ▪️ Experience with California Medi-Cal managed care plans (IEHP, Molina, Health Net, Anthem, CalOptima) ▪️ Prior experience specifically in orthotics/prosthetics billing