ZipRecruiter

Log In

2

Full Time Optum Prior Authorization Jobs (NOW HIRING)

Hopedale MC

Prior Authorization Specialist

Hopedale, IL · On-site

$18 - $23/hr

Prior Authorization Specialist, Full-time $18-$23/hour HMC Offers: * Tuition Reimbursement * Excellent benefits - health, dental, vision, and life and disability insurance * Quality childcare located ...

PainPoint

Prior Authorization Coordinator

Atlanta, GA · On-site +1

$19 - $21/hr

Prior Authorization Coordinator Full-Time | $19-21/hour | Monday-Friday | 8:00 AM-4:30 PM CST Location: Remote About DxTx Pain & Spine At DxTx Pain & Spine, we're redefining how pain and spine ...

CareMed Specialty Pharmacy

$23 - $25/hr

Senior Pharmacy Prior Authorization Specialist - CareMed Specialty Pharmacy Buffalo, NY ... This is a full-time position ideal for candidates local to the area. Remote work possible after ...

New

next page

Showing results 1-20

All JobsFull Time Optum Prior Authorization Jobs

Full Time Optum Prior Authorization information

What are Full Time Optum Prior Authorization jobs?

Full Time Optum Prior Authorization jobs involve reviewing and processing requests from healthcare providers to determine if certain medical procedures, medications, or services are covered under a patient’s health insurance plan. Employees in these roles work for Optum, a healthcare services company, and typically assess clinical documentation, apply medical policy guidelines, and communicate decisions to providers or members. These positions are full-time and may require collaboration with other healthcare professionals to ensure that patients receive appropriate and necessary care while managing costs.

What are some common challenges faced by Full Time Optum Prior Authorization specialists, and how can they be managed?

Full Time Optum Prior Authorization specialists often encounter challenges such as navigating complex insurance requirements, managing high call volumes, and ensuring timely approvals for patient medications or procedures. Staying organized, maintaining up-to-date knowledge of changing payer guidelines, and leveraging internal support tools can help manage these challenges. Collaboration with providers, pharmacists, and insurance representatives is key to resolving issues efficiently and providing excellent patient service.

What is the difference between Full Time Optum Prior Authorization vs Medical Claims Processor?

AspectFull Time Optum Prior AuthorizationMedical Claims Processor
CredentialsTypically requires healthcare-related certifications or experienceUsually requires medical billing or coding certifications
Work EnvironmentOffice-based, healthcare insurance settingOffice-based, insurance or healthcare organization
Employer & IndustryOptum, healthcare insurance industryHealth insurance companies, healthcare providers
Primary FocusReviewing and approving prior authorization requestsProcessing and reviewing medical claims for payment

Full Time Optum Prior Authorization specialists focus on evaluating prior authorization requests to ensure coverage approval, while Medical Claims Processors handle the processing and adjudication of medical claims. Both roles require healthcare knowledge but differ in their specific responsibilities within the insurance process.

What are the key skills and qualifications needed to thrive as a Full Time Optum Prior Authorization Specialist, and why are they important?

To excel as a Full Time Optum Prior Authorization Specialist, you need a strong understanding of healthcare insurance processes, medical terminology, and prior authorization requirements, often supported by experience in healthcare administration. Familiarity with electronic health record (EHR) systems, claims processing software, and Optum's proprietary platforms is typically expected. Attention to detail, excellent communication, and problem-solving abilities are crucial soft skills for effectively coordinating between providers, patients, and insurance payers. These competencies ensure timely and accurate processing of authorizations, helping patients receive appropriate care while supporting organizational efficiency and regulatory compliance.
More about Full Time Optum Prior Authorization jobs
What cities are hiring for Full Time Optum Prior Authorization jobs? Cities with the most Full Time Optum Prior Authorization job openings:
What are the most commonly searched types of Optum Prior Authorization jobs? The most popular types of Optum Prior Authorization jobs are:
What states have the most Full Time Optum Prior Authorization jobs? States with the most job openings for Full Time Optum Prior Authorization jobs include:
What job categories do people searching Full Time Optum Prior Authorization jobs look for? The top searched job categories for Full Time Optum Prior Authorization jobs are:
Full Time Optum Prior Authorization jobs near you
Infographic showing various Full Time Optum Prior Authorization job openings in the United States as of June 2026, with employment types broken down into 1% As Needed, and 99% Full Time. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.
Prior Authorization Specialist

Prior Authorization Specialist

Riverhills Neuroscience

Cincinnati, OH • On-site

$401K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 25 days ago

Job description

About Us:

For over two decades, Riverhills Neuroscience has been a pioneer in delivering exceptional neuroscience care. Our commitment to excellence extends across diagnosis, education, and treatment for those facing nervous system diseases and injuries.

Position: Prior Authorization Specialist

Location: Norwood Office

Department: Billing

Schedule: Monday-Friday, 8am-4:30pm, Hybrid, 2 days in office, 3 days remote after full in office training.

Key Benefits for Full-Time Employees:

  • Competitive pay based on experience, minimum $18
  • 401k with Profit Sharing and 4% Company Match
  • Comprehensive Medical, Dental, and Vision insurance
  • Long-Term and Short-Term Disability Insurance
  • Company Paid Life Insurance
  • Paid Holidays
  • Over three weeks of Paid Time Off
  • Continuing Education Reimbursement
  • Uniform Allowance
  • Free Parking

Responsibilities:

As a Prior Authorization Specialist at Riverhills Neuroscience, you will play a vital role in ensuring the efficiency and accuracy of our billing processes. Your responsibilities include:

  • Streamline pre-certification, authorization, and referral processes, ensuring compliance with insurance requirements
  • Coordinate with insurance entities, review organizations, and clinical contacts for effective communication and benefit determination
  • Facilitate peer-to-peer reviews for escalated encounters and address inquiries from providers, staff, and patients
  • Ensure timely and accurate insurance authorizations, conduct medical benefits investigations, and manage authorizations for botulinum toxin procedures
  • Monitor schedules for insurance coverage changes, oversee specialty pharmacy orders, and maintain/update the ordering spreadsheet
  • Initiate patient education on available assistance programs

Background and Experience:

  • 1-2 years of relevant experience in medical billing and/or prior authorization within a healthcare practice
  • Pain Management experience is a plus
  • Experience with an Electronic Medical Record (EMR) and practice management system
  • Knowledge of Medicare/Medicaid and major insurance carrier's guidelines
  • Working knowledge of ICD-9-10 medical coding and billing and medical terminology
  • Superior verbal and written skills are a must, as are sound judgement, maturity, and the ability to establish good rapport with employees, patients, physicians, and vendors

If you're eager to contribute to a world-class healthcare team, apply today. We look forward to welcoming dedicated professionals to contribute to the growth of our practice.

Equal Opportunity/Drug-Free Workplace:

Riverhills Neuroscience is an equal opportunity employer and maintains a drug-free workplace.

#IND4


Job Posted by ApplicantPro