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Aetna Prior Authorization Jobs (NOW HIRING)

Alpaca Health

Prior Authorization Manager

New York, NY · On-site +1

Prior Authorizations Manager Responsibilities: * Work with our Prior Authorizations vendor to ... Aetna, and/or Cigna * You are highly organized and relentless about follow-through, nothing falls ...

Alpaca Health

Prior Authorization Manager

New York, NY · On-site

Prior Authorizations Manager Responsibilities: * Work with our Prior Authorizations vendor to ... Aetna, and/or Cigna * You are highly organized and relentless about follow-through, nothing falls ...

Oso Home Care

Authorization Specialist

Irvine, CA · On-site

$21 - $25.90/hr

Authorization follow-up. Job Qualifications: * 2 years of prior authorization experience. * Experience in submitting authorization requests to medical payers such as Blue Cross, Blue Shield, Aetna ...

Oso Home Care

Authorization Specialist

Irvine, CA · On-site

$21 - $25.90/hr

Authorization follow-up. Job Qualifications: * 2 years of prior authorization experience. * Experience in submitting authorization requests to medical payers such as Blue Cross, Blue Shield, Aetna ...

US Tech Solutions

Registered Nurse

Wichita, KS · On-site

Staff may be required to contact the providers of record, vendors, or internal Aetna departments to ... Must have prior authorization utilization experience * Experience with Medcompass Skills: * MUST ...

DrFirst Inc.

Senior Integration Engineer

You will play a critical role in scaling direct payer integrations and prior authorization ... Design, build, and support direct payer integrations with UnitedHealthcare, Aetna, Cigna, Humana ...

Pawnee Mental Health

CLIENT LIAISON

Junction City, KS · On-site

$21.15/hr

Accessible plans to support your health needs offered through BCBS or Aetna. * Dental Insurance ... Arranges for and communicates need for prior authorization of services when required and/or when a ...

New

Pawnee Mental Health

CLIENT LIAISON

Junction City, KS · On-site

$21.15/hr

Accessible plans to support your health needs offered through BCBS or Aetna. * Dental Insurance ... Arranges for and communicates need for prior authorization of services when required and/or when a ...

New

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Aetna Prior Authorization information

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$87K

$134.7K

$189K

How much do aetna prior authorization jobs pay per year?

As of Jul 19, 2026, the average yearly pay for aetna prior authorization in the United States is $134,701.00, according to ZipRecruiter salary data. Most workers in this role earn between $104,000.00 and $163,500.00 per year, depending on experience, location, and employer.

What is an Aetna Prior Authorization job?

An Aetna Prior Authorization job involves reviewing and processing requests for medical services, medications, or procedures to determine if they meet Aetna’s coverage guidelines. Employees in this role assess medical necessity, ensure compliance with policy criteria, and communicate decisions to providers and members. They may collaborate with healthcare professionals and use clinical guidelines to make determinations. Strong attention to detail and knowledge of insurance policies are essential in this role.

What are some of the common challenges faced by Aetna Prior Authorization specialists, and how are they addressed?

Aetna Prior Authorization specialists often encounter challenges such as navigating evolving insurance requirements, managing large caseloads, and clarifying complex medical necessity criteria with providers. To address these, they rely on comprehensive training, stay updated on policy changes, and use detailed checklists and software tools to track case status and documents. Collaboration with clinical staff and insurance representatives is key to overcoming authorization barriers efficiently. A supportive team environment and ongoing professional development also help specialists stay effective and maintain accuracy in this fast-paced role.

What are the key skills and qualifications needed to thrive in the Aetna Prior Authorization position, and why are they important?

To thrive as an Aetna Prior Authorization specialist, you need a thorough understanding of medical terminology, insurance guidelines, and healthcare administrative processes, often acquired through healthcare experience or relevant certification. Familiarity with authorization software systems, electronic health records (EHR), and insurer portals is highly valued. Attention to detail, strong organizational skills, and effective communication are crucial for coordinating between providers, patients, and insurance representatives. These skills help ensure timely and accurate approval of medical services, reducing delays and supporting positive patient outcomes.

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Aetna Prior Authorization jobs near you

Prior Authorization Manager

Alpaca Health

New York, NY • On-site, Remote

Full-time

Posted 5 days ago

Job description

About Alpaca Health
Alpaca Health enables clinicians to become entrepreneurs, starting in autism care.
We help clinicians launch and scale their own clinics by providing AI-powered software, payer contracting, and full back-office infrastructure. Our goal is simple: shift power in healthcare away from large consolidated entities and back to clinicians.
We've raised over $14M in funding from early-stage investors like Core Innovation Capital, Adverb Ventures, and South Park Commons, and are building for long-term category leadership. More importantly, we're serving thousands of patients, while growing 30% - 50% MoM.
This role is full-time, remote, and based in the United States
Role: Prior Authorizations Manager
Responsibilities:
  • Work with our Prior Authorizations vendor to resolve complex authorization issues including coordinating with our providers, patients and payors
  • Be the inhouse expert for all prior authorizations and pre-certification requests and requirements for a region or set of payors
  • Support the team in chasing down documentation, resolving auth rejections, and navigating payer requirements
  • Work with the operations team to identify bottlenecks, inefficiencies, and opportunities across the intake workflow
  • Develop processes and training materials for offshore team members to resolve day-to-day prior authorization issues
  • Own Prior Authorization outcomes and KPIs for your region / payors

Who You Are
  • [REQUIRED] 5+ years of experience in ABA intake with a specific focus on Prior Authorizations or Insurance Certification
  • [REQUIRED] Strong understanding of the ABA pre-certification process for Tricare East, Medicaid MCOs, BCBS State plans, Aetna, and/or Cigna
  • You are highly organized and relentless about follow-through, nothing falls through the cracks on your watch
  • Extreme detail orientation and ability to read complex clinical documents, payor feedback, and EHR data with regards to prior authorization workflows
  • You communicate clearly and confidently with everyone from parents to clinicians to payor contacts
  • You are a problem-solver - you identify the issue and fix it
  • You are comfortable with ambiguity and can make good judgment calls in real time
  • You hold yourself to a high bar while remaining approachable and supportive

Why Join
  • The opportunity to materially impact the health outcomes of the most vulnerable populations
  • Opportunity for rapid career growth as we build out a net new function at Alpaca Health
  • Join one of the fastest growing healthcare startups in the world (between 30% - 50% monthly growth)
  • Join a team of rockstar performers who are taking a new tech first approach to building a scalable digital health platform

Apply