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Contract Insurance Prior Authorization Jobs in Wisconsin

SSM Health

Rehabilitation Services Aide

Madison, WI · On-site

$15.50 - $21.25/hr

Under direct supervision of a physical or occupational therapist, assists in providing patient care, including assistance with insurance prior authorization. Takes responsibility for equipment ...

SSM Health

Rehabilitation Services Aide

Madison, WI · On-site

Under direct supervision of a physical or occupational therapist, assists in providing patient care, including assistance with insurance prior authorization. Takes responsibility for equipment ...

Southwest Health

Referral Advocate

Platteville, WI · On-site

$17.25 - $22.50/hr

Performs prior authorization on all High-End Radiology, Referrals, and surgeries indicated by a physician order. * Assists Patient Financial Services department to insure prior authorization ...

Novir

Insurance Verification Representative

Milwaukee, WI · On-site

$16.75 - $21.50/hr

The Insurance Verification Representative (Registration Representative) supports the patient intake ... prior authorization tasks. This role is critical in creating a smooth patient experience and ...

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All JobsContract Insurance Prior Authorization JobsContract Insurance Prior Authorization Jobs in Wisconsin

Contract Insurance Prior Authorization information

What is the difference between Contract Insurance Prior Authorization vs Medical Insurance Claims Specialist?

AspectContract Insurance Prior AuthorizationMedical Insurance Claims Specialist
Primary RoleSecuring approval for specific procedures or treatments before serviceProcessing and managing insurance claims after services are rendered
Work EnvironmentHealthcare providers, insurance companies, or third-party administratorsHospitals, clinics, insurance companies, or claims processing centers
Required CredentialsKnowledge of insurance policies, healthcare regulations, often certifications in healthcare administrationUnderstanding of insurance billing, coding, and claims processing, often with certifications like CPC or CCS

Contract Insurance Prior Authorization involves obtaining approval before healthcare services, while Medical Insurance Claims Specialists handle post-service claims processing. Both roles require knowledge of insurance policies and healthcare regulations, but they focus on different stages of the insurance process.

What are the most commonly searched types of Insurance Prior Authorization jobs in Wisconsin? The most popular types of Insurance Prior Authorization jobs in Wisconsin are:
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What cities in Wisconsin are hiring for Contract Insurance Prior Authorization jobs? Cities in Wisconsin with the most Contract Insurance Prior Authorization job openings:
Contract Insurance Prior Authorization jobs near you
Infographic showing various Contract Insurance Prior Authorization job openings in Wisconsin as of July 2026, with employment types broken down into 1% As Needed, 84% Full Time, 12% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Prior Authorization/Referral Specialist

Froedtert South, Inc.

Pleasant Prairie, WI • On-site, Remote

$17 - $25.25/hr

Part-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 20 days ago

Froedtert South rating

6.9

Company rating: 6.9 out of 10

Based on 39 frontline employees who took The Breakroom Quiz

453rd of 887 rated healthcare providers

Job description

  • POSITION PURPOSE
    • The Prior-Authorization/Referral Specialist plays a key role in supporting patient access to care by verifying insurance eligibility and benefits, and securing required pre-certifications, authorizations, and referrals for both facility and professional services. This position ensures timely and accurate communication with payors and healthcare providers, obtains necessary clinical documentation to support medical necessity, and maintains detailed records throughout the authorization process.
  • MINIMUM EDUCATION REQUIRED
    • High School or GED
  • MINIMUM EXPERIENCE REQUIRED
    • One (1) year of insurance/prior authorization experience (preferred)
    • Experience and familiarity with using insurance portals
  • LICENSES / CERTIFICATIONS REQUIRED
    • None
  • KNOWLEDGE, SKILLS & ABILITIES REQUIRED
    • Strong customer service orientation with excellent interpersonal and computer skills.
    • Working knowledge of medical terminology and healthcare documentation standards.
    • Demonstrated ability to manage time effectively, prioritize tasks, and maintain accuracy in a high-volume environment.
    • Proficient with internet-based tools, email communication, and Microsoft Office applications (e.g., Word, Excel, Outlook).
    • Strong written and verbal communication skills, with the ability to interact professionally with patients, clinicians, and insurance representatives.
    • Proven experience in prior authorizations, referrals, patient registration, insurance verification, and understanding of various health insurance plans (preferred).
    • Proficient in navigating online prior authorization portals and working with multiple commercial and government payors (preferred).
    • Knowledge of medical coding systems, including ICD-10, CPT, and HCPCS codes (preferred).
  • PRINCIPLE ACCOUNTABILITIES AND ESSENTIAL DUTIES
    • Verify insurance eligibility and benefits for scheduled services to determine prior-authorization or referral requirements.
    • Initiate and follow through on prior-authorization and referral requests with payors, ensuring timely approvals.
    • Collect and submit required clinical documentation to support medical necessity and facilitate authorization.
    • Document all authorization activities accurately in the electronic health record (EHR) and/or designated tracking systems.
    • Communicate authorization status and requirements clearly to providers, clinical staff, and patients as needed.
    • Coordinate with providers and clinical teams to obtain additional information or clarification required by payors.
    • Maintain up-to-date knowledge of payer policies, coding guidelines (ICD-10, CPT, HCPCS), and authorization processes.
    • Ensure timely resolution of authorization-related issues to prevent delays or denials in patient care or billing.
    • Provide exceptional customer service when interacting with internal teams, external payors, and patients.
    • Participate in continuous quality improvement efforts, including audits, training, and performance reviews.
       
      Salary Range: $17.00 to $25.25/hr (based on experience)
       

      Benefits:

      • Medical, dental and vision benefits available
      • 403(b) company match available
      • Tuition reimbursement
      • Employee discount program
      • Competitive PTO

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