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Aetna Prior Authorization Jobs (NOW HIRING)

Varite

Registered Nurse

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 ...

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 ...

US Tech Solutions

Utilization Review Nurse

Chicago, IL · 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 ...

CVS Health

Medical Director-Medicaid (ABH VA)

$174K - $374K/yr

Aetna operates Medicaid managed care plans in Arizona, Florida, Illinois, Kentucky, Louisiana ... Prior authorization and precertification determinations * Concurrent review for inpatient and ...

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 ...

Weekday AI

Healthcare Administrative Specialist

$40 - $50/hr

Prior Authorization & Utilization Management * Initiate, submit, and monitor prior authorization ... Aetna . * Electronic Health Record (EHR) and Practice Management systems. * Healthcare ...

Stryker Corporation

$68 - $183/hr

... across Aetna Pharmacy Health Plan programs, ensuring adherence to evolving state and federal ... Oversee compliance activities and operational processes, including prior authorization and ...

Hispanic Alliance for Career Enhancement

WI · On-site

$68 - $183/hr

... across Aetna Pharmacy Health Plan programs, ensuring adherence to evolving state and federal ... Oversee compliance activities and operational processes, including prior authorization and ...

Hispanic Alliance for Career Enhancement

NY · On-site

$68 - $183/hr

... across Aetna Pharmacy Health Plan programs, ensuring adherence to evolving state and federal ... Oversee compliance activities and operational processes, including prior authorization and ...

Cytogenx

Be Seen First

Medical Billing Specialist

Stony Brook, NY · On-site

$19.75 - $25.50/hr

Aetna * Cigna * Blue Cross Blue Shield * Healthfirst * Other commercial payers * Familiarity with prior authorization and utilization management processes. * Strong analytical, organizational, and ...

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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 Aug 22, 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 95% Full Time, and 5% Part Time. Highlights an 65% In-person, and 35% Remote job distribution, with an average salary of $134,701 per year, or $64.8 per hour.

Credentialing & VOB/Authorizations Specialist ABA (Remote)

RightWay ABA

Clifton, NJ • Remote

$21 - $28/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 26 days ago

Job description

Pay: $21–$28 per hour (DOE)

About RightWay ABA

RightWay ABA is a growing Applied Behavior Analysis (ABA) therapy practice serving families across New Jersey through five center locations—Paramus, Piscataway, Jersey City, Pompton Plains, and Tinton Falls—as well as in-home and daycare-based services.

We're expanding our in-house revenue cycle team and are seeking a detail-oriented Credentialing & VOB/Authorizations Specialist to take ownership of provider credentialing, benefits verification, and authorization workflows in a fully remote environment.

About the Role

The Credentialing & VOB/Authorizations Specialist will manage provider credentialing, verification of benefits, and prior authorization submissions to ensure clinicians remain actively paneled and clients can begin services without delay. This role works closely with the Director of Billing and Intake team and offers clear ownership of a critical function within the organization.

Benefits & Perks

  • Unlimited PTO — Enjoy flexible, unlimited paid time off, provided weekly, monthly, and annual billable requirements are consistently met.

  • 401(k) Retirement Plan — Invest in your future with access to our company-sponsored 401(k) program.

  • Comprehensive Health Coverage — Medical, dental, and vision insurance available to all eligible full-time employees, with the company covering a portion of the monthly premium.

  • Fully remote

Responsibilities

  • Manage provider credentialing and recredentialing with commercial payers and Medicaid MCOs, including initial applications, CAQH maintenance, revalidations, and roster updates.

  • Verify patient benefits, including deductibles, coinsurance, out-of-pocket maximums, and ABA-specific coverage details.

  • Submit and track initial and renewal prior authorizations for ABA services.

  • Monitor authorization expiration dates and proactively coordinate renewals to prevent gaps in care.

  • Maintain accurate payer, provider, and authorization records within the practice management system.

  • Communicate with payers to resolve credentialing delays, panel status inquiries, and benefit discrepancies.

  • Partner with billing and intake teams through phone, email, and workflow tools to identify and resolve coverage issues early.

Requirements

  • Minimum of 2 years of experience in healthcare credentialing, verification of benefits, and/or prior authorizations.

  • Working knowledge of commercial and Medicaid payer processes, CAQH, and authorization workflows.

  • Strong attention to detail and the ability to manage deadlines across multiple providers and payers.

  • Excellent written and verbal communication skills.

  • Ability to work independently and remain organized in a remote environment.

  • Reliable high-speed internet connection and a private, HIPAA-compliant workspace.

Preferred Qualifications

  • Experience in ABA or behavioral health settings.

  • Familiarity with New Jersey payers, including Horizon, Aetna, UnitedHealthcare, and Medicaid MCOs.

  • Experience using EMR/practice management systems and workflow tools such as Monday.com.

  • Knowledge of ABA service authorization requirements and CPT codes, including 97151, 97153, 97155, and 97156.

To apply, please submit your resume along with a brief note describing your relevant experience.

RightWay ABA is an Equal Opportunity Employer