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Entry Level Prior Authorization Representative Express Scripts Jobs

Harmony Home Health

Authorization Representative

Murray, UT

$37K - $51K/yr

Authorization Representative We have an exciting opportunity for an Authorization Representative at ... Obtain prior authorization for services from clients' medical insurance carriers. Review client ...

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Entry Level Prior Authorization Representative Express Scripts information

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$26K

$48.4K

$73K

How much do entry level prior authorization representative express scripts jobs pay per year?

As of Jun 4, 2026, the average yearly pay for entry level prior authorization representative express scripts in the United States is $48,409.00, according to ZipRecruiter salary data. Most workers in this role earn between $40,000.00 and $55,000.00 per year, depending on experience, location, and employer.

What is the difference between Entry Level Prior Authorization Representative Express Scripts vs Customer Service Representative Express Scripts?

AspectEntry Level Prior Authorization Representative Express ScriptsCustomer Service Representative Express Scripts
Primary RoleReview and approve prior authorization requests for medicationsAssist customers with inquiries, billing, and general support
Required CredentialsHigh school diploma; healthcare knowledge preferredHigh school diploma; customer service experience preferred
Work EnvironmentOffice-based, healthcare insurance settingOffice-based, healthcare insurance setting
Common TasksEvaluate medical documentation, communicate with providersRespond to customer questions, resolve issues

While both roles are within Express Scripts and share a healthcare insurance environment, the Entry Level Prior Authorization Representative focuses on medical review and approval processes, whereas the Customer Service Representative handles customer inquiries and support. Understanding these differences helps job seekers identify the right position based on their skills and career goals.

What cities are hiring for Entry Level Prior Authorization Representative Express Scripts jobs? Cities with the most Entry Level Prior Authorization Representative Express Scripts job openings:
What are the most commonly searched types of Prior Authorization Representative Express Scripts jobs? The most popular types of Prior Authorization Representative Express Scripts jobs are:
Entry Level Prior Authorization Representative Express Scripts jobs near you
Infographic showing various Entry Level Prior Authorization Representative Express Scripts job openings in the United States as of May 2026, with employment types broken down into 46% Full Time, 50% Part Time, and 4% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $48,409 per year, or $23.3 per hour.
Prior Authorization Representative - Retina

Prior Authorization Representative - Retina

Eyesight Ophthalmic Services

Somersworth, NH • On-site

$20 - $23/hr

Full-time

Posted 9 days ago

Job description

Description:

The Prior Authorization and Patient Liaison for Retina is responsible for managing all prior authorizations and copay assistance applications related to intravitreal injections and retina-specific medications. This role serves as a key point of contact for patients, guiding them through treatment, insurance processes, and financial assistance options. Responsibilities include verifying eligibility, coordinating with payers, enrolling patients in financial assistance programs, and ensuring timely approvals to avoid treatment delays. This position supports multiple providers across locations and plays a critical role in maintaining efficient patient flow within a high-volume retina practice.


Core Behavioral Values

  • CLEAR ID: Collaborate, Learn, Empathy, Accountable, Respect, Integrity, Dedication
  • These behaviors are based on Eyesight’s culture and values critical to support the organization’s mission of providing uncompromising care to patients.


Requirements:

Essential Functions

  • Serve as a primary point of contact for retina patients, guiding them through treatment plans, insurance processes, and financial assistance options
  • Review retina clinic schedules to identify patients requiring prior authorizations
  • Verify insurance eligibility and benefit details for injectable medications and procedures
  • Obtain all necessary prior authorizations for retina injections, ensuring accurate ICD-10, CPT, and HCPCS coding
  • Submit supporting clinical documentation, including notes, diagnostics, and test results, to facilitate approvals
  • Track, follow up on, and document all pending and retro-authorization requests to prevent treatment delays
  • Maintain accurate logs of prior authorization statuses, expiration dates, and coverage limitations
  • Communicate with Medicare and commercial payers to resolve issues related to authorization delays or denials
  • Appeal denied authorizations as appropriate
  • Coordinate and apply for manufacturer-sponsored copay or patient assistance programs for eligible patients
  • Discuss treatment-related costs, payment options, and financial assistance programs with patients
  • Collaborate with providers to communicate coverage-based medication options for retina treatments
  • Collaborate with retina technicians and schedulers to ensure patients are cleared for treatment
  • Ensure all prior authorization and financial assistance outcomes are accurately documented in the EMR/PM system
  • Upload and maintain updated insurance and authorization documentation
  • Assist with insurance verification and accurate plan entry when discrepancies are identified
  • Respond to patient and clinic inquiries regarding billing, coverage, and assistance programs
  • Maintain current knowledge of payer-specific rules for specialty drugs and retina procedures

Qualifications

  • 2+ years in a medical office setting
  • Strong knowledge of insurance verification, prior authorizations and specialty drug coverage – ophthalmology or retina experience strongly preferred
  • Understanding of CPT/ICD-10 and HCPCA coding
  • Strong analytical, problem-solving, and organizational skills
  • Excellent written and verbal communication skills

Preferred

  • Proficiency in EMR/PM systems (experience with ModMed a plus)
  • Knowledge of HIPAA and patient privacy standards

Work Conditions

  • Professional healthcare setting, including clinics, administrative areas, and patient-facing environments
  • Noise level ranges from quiet to moderate, depending on location and activity
  • Potential exposure to infectious diseases, bodily fluids, or cleaning agents in accordance with standard protocols

Physical Requirements

  • Ability to sit, stand, and walk for extended periods
  • Frequent use of hands and fingers to operate medical or office equipment
  • Clear verbal and written communication; ability to hear and understand speech in person and by phone
  • Close vision required for reading small print and viewing computer screens
  • Occasional lifting or moving of objects up to 25 pounds
  • May involve reaching, bending, stooping, kneeling, or other physical movement
  • Ability to manage multiple priorities and maintain professional interactions in a dynamic setting