Prior Authorization Specialist

Remote, United States (Full Time)

Compensation: $25 per hour

Zócalo Health is a tech-enabled, community-oriented primary care organization serving people who have historically been underserved by the one-size-fits-all  healthcare system. We partner with health plans, providers, and community organizations to deliver culturally competent primary care, behavioral health, and social care.

Our model is built for populations with high medical and social complexity, where fragmented care drives poor outcomes and unnecessary cost. We combine local, community-based teams with virtual care and modern technology to deliver coordinated, whole-person care where members live and receive support.

Founded in 2021, Zócalo Health is backed by leading healthcare and mission-aligned investors and is scaling rapidly across states and populations. We are building a durable care platform designed to perform in constrained healthcare environments and to lead the shift toward accountable, value-based care.

The Prior Authorization Specialist will join Zócalo Health during a period of rapid growth and increasing operational complexity. This role exists to help scale and execute a community-oriented primary care model that delivers measurable outcomes for high-need members and health plan partners.

As a key member of our rapidly expanding team, you will drive the prior authorization process by managing timely, detailed correspondence with payers and healthcare providers to ensure strict adherence to guidelines. This role requires exceptional attention to detail in maintaining accurate, compliant, and up-to-date patient records.

This position reports to the Authorizations Manager. 

The Prior Authorization Specialist will contribute in the following ways:

• Authorization Submission: Prepare and submit detailed pre-authorization requests to insurance payers, ensuring all required medical documentation, chart notes, CPT/ICD codes, and supporting documentation are accurate and submitted within required timelines.
• Liaison & Follow-Up: Act as the central point of coordination between healthcare providers, patients, internal operational teams, and insurance companies to track prior authorization status, clarify payer requirements, and resolve outstanding requests. Authorization Tracking & Record Keeping: Maintain accurate prior authorization records within Zocalo Electronic Medical Record, including approvals, denials, effective dates, units/visits, payer communications, and required follow-up actions. 
• Denial Management: Research and assist in resolving prior authorization denials, missing information requests, payer discrepancies, and appeals in a timely manner. 
• Cross-Functional Collaboration: Collaborate closely with intake, clinical, billing, and payer operations teams to support timely authorization processing and reimbursement readiness. 

• High school diploma or equivalent required.
• 1 + year of prior authorization experience.
• Medical & Insurance Knowledge: Fluency in medical terminology and a solid understanding of major payer guidelines.
• Strong organizational skills with the ability to manage multiple priorities and high-volume workflows. 
• Ability to maintain accuracy, confidentiality, and compliance with HIPAA requirements in a remote work environment.
• Strong written and verbal communication skills.

• Direct experience with Medi-Cal Managed Care Plans
• Experience supporting Enhanced Care Management (ECM), Community Health Worker (CHW), and Community Support (CS) Services.
• Experience working with electronic health record and practice management systems, including Athena.
• Strong understanding of prior authorization workflows, including clinical review, coding accuracy, submission, denial management, appeals, and follow-up

• Competitive salary: $25 per hour
• Equity compensation package
• Comprehensive benefits including medical, dental, and vision 
• 401k
• Generous PTO policy (up to 15 days per year for FT employees)
• $1,000 home office stipend
• We provide the equipment needed for this role.
• Opportunity for rapid career progression with plenty of room for personal growth.

You must be authorized to work in the United States. Remote Work can be done from anywhere in the U.S.

At Zócalo Health Inc., we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at Zócalo Health are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. 

Those seeking employment at Zócalo Health are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.