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Medical Prior Authorization Jobs (NOW HIRING)

Advocare LLC

Prior Authorization Specalist

Marlton, NJ · On-site

$19.25/hr

A medical prior authorization specialist obtains approval from insurance companies for requested medical services and medications . Key responsibilities include gathering patient and insurance ...

Advocare LLC

Prior Authorization Specalist

Marlton, NJ · On-site

$19.25/hr

Description A medical prior authorization specialist obtains approval from insurance companies for requested medical services and medications . Key responsibilities include gathering patient and ...

Advocare LLC

Prior Authorization Specalist

Marlton, NJ · On-site

$19.25/hr

A medical prior authorization specialist obtains approval from insurance companies for requested medical services and medications . Key responsibilities include gathering patient and insurance ...

Urology Centers of Alabama

Prior Authorization

Birmingham, AL · On-site

$16.75 - $22.50/hr

Ensure all prior authorization submissions and supporting documentation accurately reflect the patient's medical record and comply with payer requirements. Physical Demands The physical demands ...

Las Vegas Pain Institute and Medical Center

Be Seen First

Prior Authorization Specialist

Las Vegas, NV · On-site

$16 - $18/hr

Prior Authorization/ B&E A Prior Authorization Specialist: A prior authorization specialist is a ... They review patient medical records and clinical notes to gather the exact information required by ...

Grace Health

Prior Authorization Specialist

Battle Creek, MI · On-site

$17 - $22.75/hr

Medical, vision, dental, life, and disability insurance * 401K match * 8 paid holidays * Employee ... Educates patients and staff about the process of medication prior authorizations. * Processes ...

Grace Health

Prior Authorization Specialist

Battle Creek, MI · On-site

$17 - $22.75/hr

Medical, vision, dental, life, and disability insurance * 401K match * 8 paid holidays * Employee ... Educates patients and staff about the process of medication prior authorizations. * Processes ...

Grace Health

Prior Authorization Specialist

Battle Creek, MI · On-site

$17 - $22.75/hr

Medical, vision, dental, life, and disability insurance * 401K match * 8 paid holidays * Employee ... Educates patients and staff about the process of medication prior authorizations. * Processes ...

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 ...

Labcorp

Prior Authorization Specialist

Burlington, NC · Remote

$17.75 - $19.50/hr

Monitor prior authorization request status, track pending cases, and perform follow-up activities ... Review insurance policies, medical policies, and payer guidelines to ensure authorization requests ...

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Medical Prior Authorization information

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$12

$22

$55

How much do medical prior authorization jobs pay per hour?

As of Sep 4, 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 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.

What are the key skills and qualifications needed to thrive as a medical prior authorization specialist?

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 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.

How do I become a medical prior authorization specialist?

To become a medical prior authorization specialist, candidates typically need a high school diploma or equivalent, along with knowledge of medical billing, insurance processes, and healthcare regulations. Relevant skills include attention to detail, communication, and familiarity with electronic health record (EHR) systems; certifications such as the Certified Medical Administrative Specialist (CMAS) can enhance job prospects.

What career paths follow medical prior authorization?

Medical prior authorization professionals often advance to roles such as healthcare compliance specialists, insurance claims analysts, or healthcare managers. They may also pursue certifications in healthcare administration or coding to expand their career opportunities within the healthcare and insurance industries.
More about Medical Prior Authorization jobs

What cities are hiring for Medical Prior Authorization jobs?

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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 August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $47,733 per year, or $22.9 per hour.

Prior Authorization Specalist

Advocare LLC

Marlton, NJ • On-site

$19.25/hr

Full-time

This job post has expired today. Applications are no longer accepted.

Advocare LLC rating

7.5

Company rating: 7.5 out of 10

Based on 34 frontline employees who took The Breakroom Quiz

232nd of 898 rated healthcare providers

Job description

A medical prior authorization specialist obtains approval from insurance companies for requested medical services and medications. Key responsibilities include gathering patient and insurance information, submitting requests, tracking their status, and communicating with patients and providers about coverage issues and denials. The role requires attention to detail, strong communication skills, and knowledge of medical terminology and insurance requirements.
Requirements
Qualifications
  • Education: A high school diploma is required.
  • Experience: Previous experience in insurance authorization is preferred.
  • Skills:
    • Knowledge of medical terminology and insurance requirements.
    • Strong attention to detail.
    • Excellent communication and interpersonal skills, both written and verbal.
    • Proficiency with computers and specialized software systems.
    • Knowledge of Portals: PEAR, Availity, UHC, UMR, Tricare, Evicore, Carelon, Resmed. Care Orchestrator, CoverMyMeds, ASPN, SureScripts is a must!
  • Process authorization requests: Initiate and complete prior authorization requests for medical services, procedures, and prescriptions.
  • Gather information: Collect and verify patient demographic, clinical, and insurance information needed to meet reimbursement and approval requirements.
  • Communicate with stakeholders: Contact insurance companies, referring physicians, and patients to gather information, clarify coverage, and resolve issues.
  • Track and monitor: Maintain accurate records of all communications and track the status of requests and appeals. Monitor schedules for add-on patients to ensure they have the necessary authorization.
  • Handle denials and appeals: Follow up on denied requests and work to ensure services are approved.
  • Ensure compliance: Verify that services are authorized within the required timeframes and that the process complies with insurance and regulatory requirements.

Work environment
  • Primarily desk work with frequent phone and computer use.
  • Often involves working in a team with other medical staff, such as Providers and Medical Assistants.
  • May involve handling a high volume of calls.

Salary Description
19.25

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