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

NexRep

Healthcare Customer Service Specialists

Apex, NC · On-site

$16/hr

Previous experience with prior authorization, medical coding, or pharmacy benefit structures is helpful. To be a successful Healthcare Customer Service Specialist for this client, it's also essential ...

Atlantic Fertility

Financial Coordinator

Raleigh, NC · On-site

Experience 3+ years of experience with insurance benefits verification, prior authorizations, patient financial services, and medical billing. Previous fertility experience is a plus but is not ...

New

Amerit Consulting

Patient Access Specialist

Cary, NC · On-site

$20 - $22.50/hr

... medical supplies & Pharmaceutical products, seeks an accomplished Patient Access Specialist ... Submit and track prior authorizations * Follow up on pending PAs and assist with appeals * Screen ...

New

Avance Care

Medical Assistant (Psychiatry)

Raleigh, NC · On-site

$15.25 - $19.50/hr

As a Medical Assistant , you'll play an essential role in delivering high-quality patient care ... Complete prior authorizations for medications and diagnostic imaging * Phone in prescriptions and ...

Actalent

Pharmacy Technician

Cary, NC · Hybrid

$17.25 - $21/hr

Apply knowledge of insurance, medical claims, and prior authorization processes when assisting patients and clinicians with coverage-related inquiries. * Demonstrate professional telephone etiquette ...

Actalent

Pharmacy Technician

Cary, NC · Hybrid

$17.25 - $21/hr

Apply knowledge of insurance, medical claims, and prior authorization processes when assisting patients and clinicians with coverage-related inquiries. * Demonstrate professional telephone etiquette ...

WakeMed

Medical Assistant

Raleigh, NC · On-site

$15.75 - $20.25/hr

Process medication requests, prior authorizations, referrals, diagnostic testing, and specialty ... Experienced Medical Assistant with a background in a specialty practice environment. * Previous ...

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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 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.

Healthcare Customer Service Specialists

NexRep

Apex, NC • On-site

$16/hr

Contractor

Posted 7 days ago

Job description

Remote Healthcare Customer Service Opportunity

Help patients access the care they need – without leaving home. If you’re someone who enjoys solving problems, staying organized, and delivering exceptional customer service, this could be the opportunity you’re looking for.

As a Healthcare Customer Service Specialist, you’ll answer inbound calls, investigate questions, coordinate solutions, and provide clear, compassionate support through every step of the process. Every conversation is an opportunity to make a meaningful impact while helping patients navigate their healthcare journey. 

If you thrive in a fast-paced environment, enjoy mastering complex processes, and take pride in creating positive customer experiences, we’d love to hear from you. 

Please Note: This is a 1099 Independent Contractor opportunity.

What You’ll Be Doing

  • Handling inbound calls and providing a positive customer support experience
  • Researching and responding to questions and concerns
  • Establishing and applying a strong working knowledge of pharmacy and medical benefit structures, insurance plans, and prior authorization processes 
  • Gathering information and coordinating with internal and external stakeholders to solve problems related to prior authorizations, appeals, and other common customer issues
  • Proactively following up with stakeholders as needed to ensure timely resolution
  • Navigating multiple computer applications and digital resources to handle time-sensitive tasks
  • Maintaining accurate documentation

About You

Prior customer service experience is required. Previous experience with prior authorization, medical coding, or pharmacy benefit structures is helpful. To be a successful Healthcare Customer Service Specialist for this client, it’s also essential to have:

  • Excellent written and verbal communication skills
  • Strong computer skills, including the ability to navigate between multiple programs and resources while assisting customers 
  • Empathy, patience, and great active listening skills
  • Strong critical thinking skills, and the ability to ask the right questions to uncover missing or unclear information
  • The ability to adapt to change in a fast-paced environment
  • Excellent attention to detail
  • The ability to maintain confidentiality and secure sensitive information

Your Home Office Environment

To be a Healthcare Customer Service Specialist, you will need a Windows PC. Chromebooks and Macs cannot be used. You will need a computer and equipment meeting the following specifications, at a minimum:

  • Access to high-speed, hardwired internet (no Wi-Fi or Satellite, please)
  • A PC with Windows 11 (Macs and Chromebooks are not supported at this time)
  • 16GB of RAM
  • 250GB of hard drive space
  • An Intel i3 9th Gen Processor or newer, or AMD Ryzen 3 Processor or newer 
  • Up-to-date antivirus software
  • Dual monitors, each capable of displaying at least 1024 x 768 pixels
  • A smartphone for multi-factor authentication
  • A USB noise-cancelling headset
  • A webcam for your Certification experience

Where NexRep Contracts

NexRep contracts with people in 31 states. You are eligible to contract with NexRep if you reside in one of these states: AL, AK, DE, FL, GA, ID, IN, IA, KS, KY, LA, MI, MS, MT, NE, NV, NH, NM, NC, ND, OH, OK, PA, SC, SD, TN, TX, UT, VA, WV, or WY. We do not currently contract with anyone outside of the US.

Hours of Operation

As an independent contractor, you’ll have the flexibility to manage your own schedule within the client’s hours of operation, which are currently Monday through Friday, 9:00 AM to 5:00 PM ET. 

Please note that our third-party client requires that independent contractors service at least 30 hours per week. If you’d prefer to service fewer than 30 hours per week as an independent contractor, you’re free to pursue a different opportunity within the NexRep Marketplace.

Pay & Perks

Healthcare Customer Service Specialists invoice at a rate of $16 per hour.

Plus, your remote, independent contractor status allows you to work in the comfort of your own home.

You’ll enjoy significant savings in expenses related to transportation, clothing, childcare or eldercare, and food. You may also qualify for home office tax deductions, but you should consult with an accountant to determine eligibility. In addition, you’ll receive:

  • Access to program experts who are available to meet with you upon request
  • Free certification to provide you with the information you need to be successful as a Healthcare Customer Service Specialist. Certification runs for 10 days, Monday-Friday from 9am-5pm ET. 
    • Supported Production, which occurs after certification, runs for two weeks.
  • The opportunity to earn a $700 certification incentive upon successful completion of Supported Production. 
  • Confidence-building call-handling experience during the certification process: you’ll handle some live customer calls independently, with other certification participants present 

You’ll also be able to take advantage of NexRep Perks, a program that recognizes the service provided by independent contractors to NexRep’s clients and their customers via the NexRep Marketplace platform. With the NexRep Perks program, you’ll have the opportunity to earn Perks points. As those points add up, you’ll unlock access to Perks – exclusive discounts and savings on a variety of common expenses such as banking services, legal support, technical support, and more!

Please note that NexRep is connecting independent contractors to exclusive discounts and savings opportunities and is not providing employee benefits nor establishing an employee benefit program. Each independent contractor makes their own decision whether to engage with a Perks Partner. NexRep receives no compensation in any form from the Perks Program.

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