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

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.

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.

IQVIA

Care Manager

Durham, NC · Remote

Provide prior authorizations and appeals support. * Assistpatients with the enrollment process for ... Minimum oneyearexperience in medical billing, reimbursement, insurance verification, or similar ...

McKesson Corporation

Reimbursement Specialist

Cary, NC · On-site

$21 - $22/hr

Obtains payer specific prior authorization procedures and documentation requirements, if applicable ... Medical claims experience. * Experience in the healthcare industry including, but not limited to ...

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 ...

McKesson

Reimbursement Specialist

Cary, NC · On-site +1

$21 - $22/hr

Obtains payer specific prior authorization procedures and documentation requirements, if applicable ... Medical claims experience. * Experience in the healthcare industry including, but not limited to ...

RALEIGH MEDICAL GROUP PA

Medical Assistant

Raleigh, NC

$18 - $23/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 ...

McKesson

Reimbursement Specialist

Cary, NC · On-site +1

$21 - $22/hr

Obtains payer specific prior authorization procedures and documentation requirements, if applicable ... Medical claims experience. * Experience in the healthcare industry including, but not limited to ...

ClinLab Solutions Group

Certified Medical Assistant

Durham, NC · On-site

$15.50 - $20/hr

Process referrals, prior authorizations, and insurance documentation. * Assist with regulatory and compliance documentation (HIPAA, OSHA, ICH-GCP for research). * Manage inventory of medical and ...

New

Adecco

Pharmacy Technician

Cary, NC · On-site

$22.50/hr

Prior Authorization Specialist ???? Specialty Pharmacy Representative ???? Pharmacy Support Specialist ???? Medical Office Coordinator ???? Healthcare Customer Service Representative ???? Insurance ...

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

Medical Prior Authorization information

See Raleigh, NC salary details

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How much do medical prior authorization jobs pay per hour?

As of Sep 4, 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 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 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 August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $46,400 per year, or $22.3 per hour.

Medical Assistant

ECAA - Anesthesia Specialists

Raleigh, NC • On-site

$15.75 - $20/hr

Full-time

Re-posted 9 days ago

Key responsibilities

  • Perform comprehensive patient intake and document medical history, chief complaint, medications, and recent imaging.

  • Complete medication prior authorizations, including appeals and denials, and review patient medical records for relevant information.

  • Collect and analyze urine samples for drug screening, review controlled substance registry, and communicate findings to the provider.

Job description

Job title: Medical Assistant  
Location: Raleigh (North), North Carolina Midtown Pain & Spine
Status: Full-Time, Non-Exempt
Department: Midtown Pain & Spine – Administrative
Reports to: Office Manager  
Job Supervisory Responsibilities: None 
Schedule: Monday – Thursday 7:30a – 4:30p; Friday 7:30a – 1:30p (for training)
Permanent Schedule will be rotating between 7a-4p, 7:30a - 4p, and 8-5 Monday through Thursday; 7a-1p, 7a-1:30p, 8a-2p on Friday
 
 
Looking for a place to build your career? Want to love where you work and what you do? Then consider our opening! Midtown Pain & Spine is North Raleigh's premier Pain Specialist. We pride ourselves in providing the safest and most innovative in-office pain management treatments and procedures. From trigger point injections to multi-modal treatments, we specialize in working with each patient's individual pain issues and using a variety of approaches to treat pain. Midtown is a division of East Carolina Pain Consultants, PLLC, North Carolina's most stable private pain practice. Our practice has committed to opioid reduction strategies by focusing on in-office procedures and a dynamic approach. To learn more about our practice, please visit: ecpcspine.com. 
 
Job Summary:
The Medical Assistant is a vital role to the pain management clinic. The Medical Assistant will utilize primarily administrative tasks to help providers in the clinic. Daily responsibilities include various administrative tasks such as conducting medication prior authorizations and documenting medical information into the electronic medical records (EMR) system. The Medical Assistant must be attentive to patient needs and communicate any potential issues to staff. The Medical Assistant identifies patients’ needs, provides safe and professional care, and communicates any needs to the provider. The Medical Assistant will have to demonstrate professionalism and tact during difficult patient situations. The Medical Assistant will: 
 
Duties/Responsibilities: 
  • Independently perform a comprehensive patient intake by documenting the past medical and surgical history, chief complaint, medications and recent imaging.  
  • Present the patient history and chief complaint to the provider prior to their examination.
  • Document the patient encounter in our EMR system.
  • Prepare relevant diagnostic imaging to be reviewed with the provider.
  • Complete medication prior authorizations, including appeals and denials.
  • Review new patient medical records for relevant past treatments, medications and health history. Summarize findings to be reviewed by manager.
  • Collect urine samples for drug screening, analyze the results to assess patient compliance and report non-compliance to the provider.
  • Review patients’ controlled substance registry and report inconsistencies to the provider.
  • Collect pre-and post-procedural vitals for interventional procedures.
  • Reduce the provider workload by performing tasks and anticipating their needs essential to efficient patient care.
  • Return phone calls from patients, pharmacies and insurance companies in a timely manner to prevent delays in patient treatment.
  • Respond to incoming faxes.
  • Maintain a pleasant and cooperative demeanor while performing all duties.
  • Keep an open line of communication with co-workers and providers regarding patient needs.
  • Perform other duties as assigned.
 
Education and Experience:
  • Bachelor’s degree preferred, but not required.
  • Previous experience in a specialty medical office and EMR systems is preferred, but not required.
  • Registered/Certification preferred but not required
 
Required Skills/Abilities:
  • Ability to communicate effectively and clearly, both in written and oral communication.
  • Ability to handle high patient volumes in a professional manner.
  • Ability to maintain composure in stressful situations.
 
Work Environment:
  • Work performed in an office environment.
  • Involves frequent contact with patients, physicians, and medical office staff.
ECAA is an equal opportunity employer and does not discriminate against any applicant or employee on the basis of age, race, color, religion, sex, national origin, genetic information, disability, or other legally protected status.  This policy extends to all terms, conditions, and privileges of employment, as well as the use of the Company's facilities and participation in all activities sponsored by the Company.