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How much do aetna prior authorization jobs pay per year?

As of Sep 7, 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?

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 skills and qualifications are needed for an Aetna Prior Authorization?

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.

What are 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.

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Aetna Prior Authorization jobs near you
Infographic showing various Aetna Prior Authorization job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 91% In-person, and 9% Remote job distribution, with an average salary of $134,701 per year, or $64.8 per hour.

Virtual Medical Assistant (VMA) + Prior Authorization Specialist

Staffingly, Inc

Remote

$18.50 - $24.50/hr

Other

Posted 3 days ago

New

Job description

Virtual Medical Assistant (Vma) + Prior Authorization Specialist – Gastroenterology & Rheumatology

Type: Full-Time | Remote Shift Timing: U.S. Time Zones (EST/CST/PST depending on client) Start Date: Immediate

At Staffingly, Inc., we are a trusted partner for healthcare organizations across the United States, offering end-to-end administrative, clinical, and operational support. Our goal is to help medical practices focus on patient care while we streamline workflows, improve communication, and ensure smooth revenue operations.

We are currently seeking an experienced Virtual Medical Assistant with Prior Authorization expertise in Gastroenterology and Rheumatology to join our growing healthcare operations team. This position plays a critical role in coordinating patient care, ensuring timely authorizations, and supporting providers and patients through efficient communication and documentation.

Position Overview

The VMA + Prior Authorization Specialist will assist providers in day-to-day clinical and administrative tasks, manage patient communications, schedule appointments, verify eligibility, and obtain prior authorizations for specialty medications, infusions, and diagnostic procedures — specifically within Gastroenterology and Rheumatology practices.

Key Responsibilities

Virtual Medical Assistant (VMA)

  • Handle patient intake, appointment scheduling, rescheduling, and confirmations via EMR or practice management systems.
  • Communicate with patients regarding lab results, prescriptions, and follow-ups.
  • Update and maintain accurate patient demographics, medication lists, and visit notes.
  • Coordinate between providers, billing teams, and patients to ensure a seamless care experience.
  • Maintain confidentiality and compliance with HIPAA standards.

Prior Authorization (PA)

  • Verify patient eligibility and benefits through payer portals or phone calls.
  • Initiate and process Prior Authorization requests for specialty medications, biologics, infusions, endoscopies, colonoscopies, and other gastro/rheumatology-specific procedures.
  • Review clinical documentation and ensure all required information is available for payer submission.
  • Communicate with insurance companies, providers, and patients to follow up on approval status.
  • Manage denials and re-submissions, ensuring timely updates to the care team.
  • Maintain accurate tracking and documentation of all PA requests in the EMR.

Key Requirements

  • Minimum 2+ years of experience as a Virtual Medical Assistant or Prior Authorization Specialist.
  • Experience working with Gastroenterology and/or Rheumatology specialties is mandatory.
  • Strong knowledge of ICD-10, CPT, and HCPCS codes related to these specialties.
  • Hands-on experience with EMRs such as eClinicalWorks, Athenahealth, AdvancedMD, or similar.
  • Familiarity with payer portals (Availity, NaviNet, Cigna, Aetna, UnitedHealthcare, etc.).
  • Excellent English communication skills (verbal and written).
  • Strong attention to detail, time-management, and multitasking skills.
  • Reliable high-speed internet, computer system, and a quiet workspace for remote work.

Benefits

  • Provident Fund contributions.
  • Overtime and night-shift allowances.
  • Referral and birthday bonuses.
  • Paid holidays and performance recognition programs.
  • “Employee of the Month” award and incentives.

Apply