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Medical Prior Authorization Jobs (NOW HIRING)

Equitas Health

Prior Authorization Specialist

Columbus, OH · On-site

$18.13 - $21.78/hr

The Prior Authorization Specialist handles all prior authorizations, third party appeals, and pending third party payer issues across all Equitas Health medical centers. This individual will work ...

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Medical Prior Authorization information

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$55

How much do medical prior authorization jobs pay per hour?

As of Jul 22, 2026, the average hourly pay for medical prior authorization in the United States is $22.95, according to ZipRecruiter salary data. Most workers in this role earn between $17.55 and $24.28 per hour, depending on experience, location, and employer.

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

AspectMedical Prior AuthorizationMedical Claims Specialist
Required credentialsOften requires healthcare or insurance-related certificationsTypically requires insurance or billing certifications
Work environmentHealthcare offices, insurance companies, or hospitalsInsurance companies, healthcare providers, or billing departments
Employer and industry usageUsed in healthcare and insurance to approve proceduresUsed in insurance to process and adjudicate claims
Common search and comparison intentUnderstanding approval process for treatmentsUnderstanding claims processing and reimbursement

Medical Prior Authorization involves obtaining approval from insurance before certain treatments or procedures, ensuring coverage. Medical Claims Specialists handle the processing and reimbursement of insurance claims after services are provided. While both roles work within healthcare insurance, prior authorization focuses on pre-approval, whereas claims specialists manage post-service billing and claims processing.

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

To thrive as a Medical Prior Authorization Specialist, you need in-depth knowledge of insurance policies, medical terminology, and healthcare regulations, typically supported by experience in medical billing or healthcare administration. Proficiency in prior authorization software, electronic health record (EHR) systems, and understanding of payer portals is essential. Strong attention to detail, excellent communication, and organizational skills help you navigate complex approval processes and interact effectively with providers and insurers. These skills ensure timely and accurate authorization of medical services, reducing delays in patient care and minimizing claim denials.

What are some common challenges faced in a Medical Prior Authorization role, and how are they typically addressed?

A common challenge in Medical Prior Authorization is managing high volumes of requests while ensuring timely and accurate approvals. Specialists often deal with complex insurance policies and must coordinate closely with healthcare providers and insurance companies to obtain necessary documentation. To address these challenges, most teams utilize specialized software and standardized workflows, and regular training is provided to stay updated on changing regulations. Strong communication and organizational skills are essential for navigating these complexities and ensuring patients receive prompt care.

What is medical prior authorization?

Medical prior authorization is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication before it is provided. Providers must submit a request for approval, including supporting documentation, to the insurance company. This process helps ensure that the service is medically necessary and meets the insurer's coverage criteria. Obtaining prior authorization does not guarantee payment, but it is often required to avoid claim denials and delays in patient care.
More about Medical Prior Authorization jobs
What cities are hiring for Medical Prior Authorization jobs? Cities with the most Medical Prior Authorization job openings:
What states have the most Medical Prior Authorization jobs? States with the most job openings for Medical Prior Authorization jobs include:
Medical Prior Authorization jobs near you
Infographic showing various Medical Prior Authorization job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $47,733 per year, or $22.9 per hour.
Supervisor, Medical Prior Authorization

Supervisor, Medical Prior Authorization

House Rx

Pittsburgh, PA • On-site

Full-time

Medical, Dental, Vision, PTO

Posted 13 days ago

Job description

House Rx is on a mission to make specialty medications more affordable and accessible for patients suffering from chronic illnesses like cancer and autoimmune disorders. We provide clinics with specialized technology and support from pharmacists and care coordinators to dispense medication directly to their patients, known as medically integrated dispensing (MID).
The Medication Authorization Supervisor is responsible for building the playbook and leading the daily operations of the Medical Benefit Authorization team. This leader ensures patients receive timely access to therapy by driving operational excellence across benefit investigations, medical prior authorizations, payer documentation, appeals, and authorization renewals.
This role balances people leadership with operational ownership, ensuring quality, productivity, turnaround time, and customer satisfaction while continuously improving workflows across multiple specialties.
What You'll Do
Team Leadership
  • Lead, coach, and develop a team of Medication Authorization Specialists.
  • Monitor daily workload and staffing to meet service level expectations.
  • Conduct quality reviews, provide coaching, and implement performance improvement plans when necessary.
  • Train new employees and establish ongoing competency programs.
  • Foster a culture focused on accountability, collaboration, and continuous improvement.
Operational Excellence
  • Oversee end-to-end medical authorization workflows for provider-administered specialty medications.
  • Ensure timely submission of medical prior authorizations, predeterminations, and supporting clinical documentation.
  • Monitor authorization turnaround times and proactively resolve barriers impacting patient care.
  • Develop and maintain standard operating procedures.
  • Partner with Product and Operations teams to improve workflows and automate manual processes.
  • Identify trends impacting payer approvals and implement process improvements.
Clinical & Reimbursement Expertise
  • Serve as the escalation point for complex medical authorization cases.
  • Maintain expertise in commercial, Medicare Advantage, Medicaid, and other payer medical policies.
  • Review payer guidelines, clinical criteria, and authorization requirements.
  • Support appeals and peer-to-peer preparation when appropriate.
  • Collaborate with providers and clinical staff to obtain necessary documentation.
Cross-Functional Collaboration
  • Partner closely with Customer Success, Operations, Pharmacy, Finance, and Implementation teams.
  • Communicate payer changes that impact customer workflows.
  • Support implementation of new clinics and specialty service lines.
  • Participate in customer escalations as the medical authorization subject matter expert.
Performance Management
  • Monitor KPIs including:
    • Authorization turnaround time
    • Approval rate
    • First-pass submission quality
    • Productivity
    • Appeal success rate
    • Customer SLA adherence
  • Utilize reporting to identify trends and implement corrective actions.
Qualifications
Required
  • 5+ years of experience in medical benefit prior authorizations or specialty reimbursement.
  • 2+ years of people leadership or supervisory experience.
  • Experience supporting provider-administered specialty medications.
  • Strong knowledge of commercial, Medicare, and Medicaid medical benefit authorization processes.
  • Experience with infusion therapies, biologics, oncology, rheumatology, gastroenterology, neurology, or dermatology medications.
  • Strong understanding of payer medical policies and clinical documentation requirements.
  • Exceptional organizational and communication skills.
  • Ability to manage multiple priorities in a fast-paced environment.
Preferred
  • Experience working within specialty pharmacy, physician dispensing, infusion centers, or specialty physician practices.
  • Experience with appeals, medical necessity documentation, and peer-to-peer support.
  • Knowledge of EMRs such as Epic, eClinicalWorks, or OncoEMR.
  • Experience with specialty reimbursement platforms and authorization management systems.
  • Bachelor's degree or equivalent healthcare experience
Why You Should Join Our Team
A career at House Rx offers the chance to work with a talented group of entrepreneurs, healthcare professionals, and technology builders who are passionate about improving specialty care and making it easier for patients to access the medication that they need.
At House Rx, we strive to build and maintain an environment where employees from all backgrounds are valued, respected, and have the opportunity to succeed. You'll find a culture that supports open communication, embracing failure as a learning opportunity, and always being open to new ideas-no matter how radical. We're committed to creating a positive and collaborative culture to achieve our mission, all while supporting our team members in all aspects of their lives-at home, at work, and everywhere in between.
In particular, we offer:
  • Flexible paid time off
  • Generous parental leave
  • Comprehensive healthcare, vision and dental benefits
  • Competitive salary and equity stake

We're backed by forward-thinking investors committed to transforming healthcare, including Bessemer Venture Partners, First Round Capital, NEA, Town Hall Ventures, Khosla Ventures, Maverick Ventures, 1984.vc, and Character.

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