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Medical Prior Authorization Jobs in Wisconsin (NOW HIRING)

Jobless

WI · On-site

$52 - $75/hr

Cabinet Peaks Medical Center is seeking a team-oriented Prior Authorization Specialist to work in the Business Office! Reporting to the Director of Revenue Cycle, this position is responsible for ...

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EYE CLINIC OF WISCONSIN

Medical Technician

Wausau, WI · On-site

$19.50 - $26.50/hr

... prior authorization requests Perform additional duties as assigned Knowledge, Skills, and Abilities: Certification as a medical assistant is preferred Experience as a medical assistant is preferred ...

Eye Clinic of Wisconsin

Medical Technician

Wausau, WI · On-site

$19.50 - $26.50/hr

... prior authorization requests Perform additional duties as assigned Knowledge, Skills, and Abilities: Certification as a medical assistant is preferred Experience as a medical assistant is preferred ...

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All JobsMedical Prior Authorization JobsMedical Prior Authorization Jobs in Wisconsin

Medical Prior Authorization information

See Wisconsin salary details

$12

$23

$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 Wisconsin is $23.16, according to ZipRecruiter salary data. Most workers in this role earn between $17.69 and $24.52 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.

What cities in Wisconsin are hiring for Medical Prior Authorization jobs?

Cities in Wisconsin with the most Medical Prior Authorization job openings:

Medical Prior Authorization jobs near you
Infographic showing various Medical Prior Authorization job openings in Wisconsin as of August 2026, with employment types broken down into 83% Full Time, 13% Part Time, and 4% Temporary. Highlights an 100% In-person job distribution, with an average salary of $48,179 per year, or $23.2 per hour.

Medical Insurance Authorization Specialist

Neuroscience Group

Appleton, WI

$20 - $24/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 13 days ago

Job description

Description

Prior Authorization Specialist


Join a Team That Keeps Patient Care Moving Forward


Neuroscience Group is growing, and we're excited to expand our Prior Authorization team! We are seeking a full-time Prior Authorization Specialist to join our Clinical Services team. This position works Monday through Friday, 8-hour daytime shifts, with no nights, weekends, or holidays.


As a Prior Authorization Specialist, you'll play a vital role in helping patients receive timely access to the testing, procedures, and treatments they need. Working closely with providers, clinical staff, insurance companies, and patients, you'll ensure prior authorizations are obtained efficiently and accurately while helping remove barriers to care. If you enjoy solving problems, thrive in a fast-paced environment, and take pride in providing exceptional customer service, we'd love to hear from you.


About Neuroscience Group


For more than 30 years, Neuroscience Group has been the region's leader in comprehensive brain, spine, and pain care. As Northeast Wisconsin's only practice bringing together neurosurgery, neurology, orthopedic spine surgery, interventional and non-interventional pain management, and physical therapy, we are committed to improving lives through exceptional patient care.


Today, our team of more than 50 providers serves patients throughout the Fox Valley and Northeast Wisconsin across nine outreach clinics. Everything we do is guided by our core values.


When you join Neuroscience Group, you become part of a collaborative team that is committed to excellence-for our patients and for one another.

Requirements

What Do You'll


As a Prior Authorization Specialist, you will:


  • Verify patient insurance coverage and maintain accurate demographic and insurance information.
  • Review provider orders, medical documentation, CPT codes, diagnosis codes, and insurance requirements to determine authorization needs.
  • Submit prior authorization requests through payer portals, fax, and telephone for diagnostic testing, procedures, and treatments performed both within Neuroscience Group and at outside facilities.
  • Gather and upload supporting clinical documentation from Epic, Care Everywhere, and external medical records.
  • Monitor pending authorization requests and proactively follow up to ensure timely approvals.
  • Communicate authorization approvals, denials, and insurance requirements with patients, providers, and clinical teams.
  • Coordinate peer-to-peer reviews between providers and insurance carriers when required.
  • Assist providers with appeals by gathering documentation and supporting appeal submissions.
  • Maintain accurate documentation and records to ensure continuity of patient care.
  • Manage incoming and outgoing documentation through FaxFinder cloud faxing.
  • Collaborate closely with physicians, clinical staff, reimbursement services, outside facilities, and fellow team members.
  • Participate in department meetings and continuous process improvement initiatives.
  • Perform additional duties as assigned.

What We're Looking For


Successful candidates will have:


  • Previous experience with medical prior authorization or precertification.
  • Working knowledge of commercial insurance, Medicare, Medicaid, Workers' Compensation, VA, and other third-party payers.
  • Experience with CPT and ICD-10 coding.
  • Previous Epic experience preferred.
  • Strong understanding of medical terminology.
  • Excellent organizational skills and exceptional attention to detail.
  • Outstanding written and verbal communication skills.
  • Strong customer service skills with a patient-first mindset.
  • Critical thinking skills and the ability to prioritize multiple tasks in a high-volume environment.
  • Proficiency with Microsoft Office and general computer applications.
  • The ability to work both independently and collaboratively within a team.
  • Physical Requirements
  • Primarily seated work with occasional standing, bending, stretching, and reaching.
  • Ability to lift supplies weighing up to 20-30 pounds.
  • Occasional assistance with wheelchair transfers may be required.
  • Ability to operate standard office equipment.
  • Sufficient visual acuity, hearing, and manual dexterity to perform essential job functions.

Why Join Neuroscience Group?


We believe outstanding employees deserve outstanding benefits. In addition to a competitive compensation package, we offer:


  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • Health Savings Account with generous employer contribution
  • Company-paid Life Insurance
  • Company-paid Long-Term Disability Insurance
  • Voluntary Short-Term Disability
  • Voluntary Life Insurance
  • Voluntary Accident and Critical Illness Insurance
  • Competitive compensation based on experience
  • 401(k) with guaranteed employer contribution
  • Profit Sharing
  • Cash Balance Pension Plan
  • Generous Paid Time Off
  • Separate Sick Leave Bank
  • Employee Assistance Program
  • Timber Rattlers tickets
  • Employee Appreciation Day, Annual Summer Picnic, Holiday Celebration, Years of Service Recognition
  • A supportive, collaborative workplace where your contributions make a meaningful difference every day.


If you're looking for an opportunity to combine your insurance knowledge, attention to detail, and passion for helping patients in a respected, physician-led specialty practice, we'd love to meet you. Apply today and become part of the Neuroscience Group team.

Apply