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Medical Prior Authorization Jobs (NOW HIRING)

Slocum

Prior Authorization

Eugene, OR · On-site

$18 - $24/hr

* Submits, tracks, and manages prior authorization requests for medical and ancillary procedures, within strict timeframes. * Researches and resolves authorization and referral claim denials, while ...

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 ...

CareMed Specialty Pharmacy

$23 - $25/hr

Pharmacy Prior Authorization Specialist - CareMed Specialty Pharmacy Buffalo, NY | Full-Time | ... Medical; Dental; Vision * 401k with a match * Paid Time Off and Paid Holidays * Tuition ...

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Medical Prior Authorization information

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$12

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$55

How much do medical prior authorization jobs pay per hour?

As of Jun 10, 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.
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Medical Prior Authorization jobs near you
Medical Prior Authorization Specialist

Medical Prior Authorization Specialist

American Family Care

Hinsdale, IL • On-site

$18 - $24/hr

Full-time

Posted yesterday

Job description

Company Overview:
Modern Pain Consultants is a renowned Interventional Pain Practice committed to providing exceptional patient care and innovative pain management solutions. We are a well-established, higher volume Interventional Pain Practice seeking a seasoned, talented full-time Prior Authorization Specialist with a can-do attitude and strong professionalism. You must be computer savvy for this position. We are EMR - based, using EMA; Experience with EMA is very beneficial, but not required. Looking for candidates who want a long-term, stable position with opportunity for advancement.
Position Highlights:
The Prior Authorization Specialist is responsible for obtaining and resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all payers. In addition, the Prior Authorization Specialist may be responsible for pre-appointment registration and insurance review to maximize the submission of a clean claim.
Position Responsibilities:
- Reviews, collects and properly records demographic and insurance information required to properly address the customers' authorization requirements and identify any financial issues. Verifies patient's eligibility from resources provided by third party payers and portals and other on lines services.
-Collects and analyzes demographic, insurance and other information from the patient, guarantor and all other sources to accurately obtain authorization for scheduled procedure.
-Assembles information concerning the patient's clinical background and clinical information that is required for the payer to issue a referral or an authorization. Per referral guidelines, provide appropriate clinical information to the payer.
-Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, CPT codes and clinical notes.
-Performs registration functions consistent with Federal, State and Local regulatory agencies and payer requirements, and organizational policies and procedures, including HIPAA privacy.
-Consistently maintains authorization accuracy rates at and or above department standard in performance of registration and authorization duties.
- Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor.
- Receives and properly responds to, or directs telephone and electronic inquiries from patients, payers, physicians and their staff, internal department and other persons and entities.
-Ability to exercise good customer service skills when communicating with both our patients as well as our internal customers.
-Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor.
-Performs other duties as assigned for the operational effectiveness and success of the department.
Required Job Qualifications:
- High school graduate or equivalent.
- 1 year of experience
- Excellent communication and outstanding customer service and listing skills.
- Basic keyboarding skills
- Ability to analyze and interpret data
- Critical thinking, sound judgment and strong problem-solving skills essential
- Team oriented, open minded, flexible, and willing to learn
- Strong attention to detail and accuracy required
- Ability to prioritize and function effectively, efficiently, and accurately in a multi-tasking complex, fast paced and challenging department.
- Ability to follow oral and written instructions and established procedures
- Ability to function independently and manage own time and work tasks
- Ability to maintain accuracy and consistency
- Ability to maintain confidentiality
- Experience in Pain Specialty is Preferred
American Family Care is the leading provider of urgent care with more than 200 centers nationally and ranked by Inc. Magazine as one of the fastest-growing companies in the U.S. We offer a fast-paced, collaborative environment with health benefits and opportunities for advancement within a growing organization. We have locations in Willowbrook, IL and coming soon in Naperville, IL
American Family Care Bloomfield logo

About American Family Care Bloomfield

Sourced by ZipRecruiter

It is our mission to provide the best healthcare possible in a kind and caring environment while respecting the rights of all patients, in an economical manner, at times and locations convenient to the patient. All AFC clinics are designed, equipped, and staffed to provide accessible primary care, urgent care, minor emergency treatment, and occupational medicine. We are considered pioneers in non-emergency room urgent care, with a majority of our patients coming in, receiving care, and returning home in one hour’s time on average.

Industry

Outpatient health care

Company size

1,001 - 5,000 Employees

Headquarters location

Bloomfield, NJ, US

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