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Aetna Prior Authorization Jobs (NOW HIRING)

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 ...

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 ...

CVS Health

Medical Director - Commercial

New York, NY · Remote

$174K - $374K/yr

Position Summary Aetna, a CVS Health Company, is one of the oldest and largest national insurers ... This includes Prior Authorization/Pre-Certification/Concurrent Reviews/Peer to Peer calls/First ...

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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 26, 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.

More about Aetna Prior Authorization jobs
What cities are hiring for Aetna Prior Authorization jobs? Cities with the most Aetna Prior Authorization job openings:
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Aetna Prior Authorization jobs near you
Infographic showing various Aetna Prior Authorization job openings in the United States as of July 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $134,701 per year, or $64.8 per hour.
Patient Care Specialist - Data Entry and Prior Authorization

Patient Care Specialist - Data Entry and Prior Authorization

Carepoint Healthcare LLC

Schaumburg, IL • On-site

$20 - $23/hr

Full-time

Posted 3 days ago

Job description

Qualifications:

Active Pharmacy Technician License required

Active Pharmacy Technician Certification required (PTCB, ExCPT or Grandfathered)

  1. Experience with ALL Major insurances (PBM)
  2. Aetna
  3. BCBS (Prime)
  4. United healthcare (optum)
  5. Caremark
  6. ESI (express scripts)

Able to read, understand and translate medical charts into the prior authorization format.

Understand Pharmacy Benefits and Deductibles.

Understands diagnosis codes: icd10 codes and how to better utilize them.

Can properly navigate through Cover My Meds to properly fill out forms with medical chart info or Patient medical history.

Able to read and translate Pharmacy scripts.

Must be employed at least 6 months with the organization.


Responsibilities

Calling patients and providers to obtain clinical information needed to complete prior authorization if none provided on script or original fax.

Effectively and efficiently fill out prior authorization forms without missing details.

Following up with insurance for outcomes of the prior authorizations based on submission date and ability to stay on task based on required. completion date.

Need to be detail oriented.

Replying to sales inquiries and inquiries from team members to provide updates or handling customer service calls based on status or doctors’ office calling to update or provide requirements.

Completing prior authorizations within a 14-day time frame or earlier based on supervisors’ expectations.

Must meet perfect attendance and able to rotate through shifts to allow a team member to always be available during hours of operation.