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Medical Prior Authorization Jobs in Raleigh, NC (NOW HIRING)

Spectraforce Technologies

Clinical Pharmacist 1

Raleigh, NC · On-site

$115K - $137K/yr

Applies Medical Policy Criteria to prior authorization requests. * Evaluates whether request meets criteria for approval. * Reviews the request using professional clinical judgment on a case by case ...

EmergeOrtho

Medical Assistant

Smithfield, NC · On-site

$15.25 - $19.75/hr

Obtains prior authorization for procedures, equipment, and medication, if appropriate * Schedules ... medical team includes upwards of 170 highly trained orthopedic specialists and nearly as many ...

EmergeOrtho

Medical Assistant

Smithfield, NC · On-site

$15.25 - $19.75/hr

Obtains prior authorization for procedures, equipment, and medication, if appropriate * Schedules ... medical team includes upwards of 170 highly trained orthopedic specialists and nearly as many ...

EmergeOrtho

Medical Assistant

Durham, NC · On-site

$16 - $20.75/hr

Obtains prior authorization for procedures, equipment, and medication, if appropriate * Schedules ... medical team includes upwards of 170 highly trained orthopedic specialists and nearly as many ...

EmergeOrtho

Medical Assistant

Raleigh, NC · On-site

$17.25 - $22/hr

Medical Assistant Opportunity in the Triangle Region! EmergeOrtho is committed to being the trusted ... Obtains prior authorization for procedures, equipment, and medication, if appropriate * Schedules ...

ECAA Anesthesia Specialists

Medical Assistant

Raleigh, NC

$15.75 - $20/hr

Daily responsibilities include various administrative tasks such as conducting medication prior authorizations and documenting medical information into the electronic medical records (EMR) system.

ECAA - Anesthesia Specialists

Medical Assistant

Raleigh, NC · On-site

$15.75 - $20/hr

Daily responsibilities include various administrative tasks such as conducting medication prior authorizations and documenting medical information into the electronic medical records (EMR) system.

RALEIGH MEDICAL GROUP PA

Medical Assistant

Raleigh, NC

$17.25 - $22/hr

Medical Assistant (MA) - Gastroenterology Raleigh, NC | In-Office Support quality patient care ... Coordinates procedures, referrals, and prior authorizations * Processes prescription refill ...

RALEIGH MEDICAL GROUP PA

Medical Assistant

Raleigh, NC

$23 - $25/hr

... prior authorizations, referrals, and patient follow-up as directed * Provide patients with pre- and ... Medical Assistant certification * Dermatology, surgical, or procedural experience * Experience with ...

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All JobsMedical Prior Authorization JobsMedical Prior Authorization Jobs in Raleigh, NC

Medical Prior Authorization information

See Raleigh, NC salary details

$12

$22

$53

How much do medical prior authorization jobs pay per hour?

As of Jul 27, 2026, the average hourly pay for medical prior authorization in Raleigh, NC is $22.31, according to ZipRecruiter salary data. Most workers in this role earn between $17.07 and $23.61 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.
What cities near Raleigh, NC are hiring for Medical Prior Authorization jobs? Cities near Raleigh, NC with the most Medical Prior Authorization job openings:
Medical Prior Authorization jobs near you
Infographic showing various Medical Prior Authorization job openings in Raleigh, NC as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $46,398 per year, or $22.3 per hour.

Authorization Specialist

RALEIGH MEDICAL GROUP PA

Raleigh, NC

$16 - $21.25/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

Job description

Title:

Authorization Specialist - RMG

Location:

In-Office – Raleigh, NC

Department:

Infusion

Shift:

Monday - Friday FT

Authorization Specialist – Infusion
Raleigh, NC | In-Office

Support patient access to care—every day.

Raleigh Medical Group, PA, is seeking an Authorization Specialist to support timely and accurate prior authorizations for medications, diagnostic procedures, and specialty services across the organization. This role plays an important part in ensuring patients receive access to care without unnecessary delays while maintaining strong communication with patients, providers, pharmacies, and insurance companies.

The Authorization Specialist works collaboratively with clinical and administrative teams to verify insurance requirements, monitor authorization status, and ensure accurate documentation within the EHR and practice management system..

Key Responsibilities
  • Obtain prior authorizations and pre-certifications for medications, procedures, and specialty services
  • Verify insurance benefits and identify authorization requirements as needed
  • Monitor authorization status and follow up to prevent delays in patient care
  • Communicate with patients, providers, pharmacies, and insurance companies regarding authorization requirements and updates
  • Accurately document authorization and benefit information in the EHR and practice management system
  • Maintain current knowledge of payer guidelines and authorization processes
  • Collaborate with clinical and front office staff to coordinate patient care efficiently
  • Communicate workflow updates and payer changes to appropriate team members
  • Participate in departmental meetings and training sessions
  • Assist with onboarding and cross-training of team members as requested
  • Maintain compliance with HIPAA regulations and safeguard Protected Health Information (PHI)
  • Perform other duties as assigned
Qualifications

Required:


•    High school diploma or equivalent required

  •  Minimum of 1 year of medical office and EHR experience
  •  Prior authorization experience required
  •  Strong communication, organization, and customer service skills
  • Attention to detail and ability to prioritize tasks effectively
  • Ability to work independently with minimal supervision
Why Join Raleigh Medical Group?
  • Meaningful work supporting patient access to care
  • Collaborative, team-oriented environment
  • Opportunity for professional growth and development
  • Supportive leadership and training opportunities
We Offer Our Valued Employees
  • Group Health, Dental, and Vision coverage
  • FSA and HSA options
  • Generous Paid Time Off (PTO)
  • 401(k) Retirement Plan with employer matching
  • Company-paid Life, Short-Term and Long-Term Disability
  • Competitive pay

EEO Statement:

Raleigh Medical Group, PA is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, or national origin, or any other characteristic protected under applicable federal, state, or local law.

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