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Medical Prior Authorization Jobs (NOW HIRING)

Infusion4Health Inc

Prior Authorization Specialist

Brea, CA · On-site

$23 - $27/hr

... medical necessity documentation to expedite approvals and ensure that appropriate follow-up is ... Document all prior authorization information, including approval dates, billing units, procedure ...

Actalent

Prior Authorization Specialist

Randolph, NJ

$18.50 - $24.75/hr

Utilize ModMed as the electronic medical record (EMR) system to maintain and update patient records ... Recent prior authorization experience, specifically handling authorizations for procedures and ...

Actalent

Prior Authorization Specialist

Ogdensburg, NJ

$18.50 - $24.75/hr

Utilize ModMed as the electronic medical record (EMR) system to maintain and update patient records ... Recent prior authorization experience, specifically handling authorizations for procedures and ...

Lumera Healthcare

Prior Authorization Associate

Paducah, KY · On-site

$18.25 - $22.50/hr

Submit complete, timely, and accurate prior authorization requests to insurance companies and ... Previous experience in Behavioral Health medical billing /coding, or referral coordination ...

Actalent

Prior Authorization Specialist

Denville, NJ

$17.25 - $23/hr

Utilize ModMed as the electronic medical record (EMR) system to maintain and update patient records ... Recent prior authorization experience, specifically handling authorizations for procedures and ...

MC-Rx

Prior Authorization Coordinator

Miramar, FL · On-site

$21 - $23/hr

Manage the full lifecycle of prior authorization (PA) requests in support of manufacturer-sponsored ... Strong understanding of medical terminology, insurance plans and authorization. * Bilingual English ...

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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.
More about Medical Prior Authorization jobs
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What states have the most Medical Prior Authorization jobs? States with the most job openings for Medical Prior Authorization jobs include:
What job categories do people searching Medical Prior Authorization jobs look for? The top searched job categories for Medical Prior Authorization jobs are:
Medical Prior Authorization jobs near you

Prior Authorization Department

One Stop Hospice Inc

Santa Ana, CA

$25/hr

Full-time

Posted 21 days ago

Job description


Position Title
Prior Authorization Specialist / Prior Authorization Coordinator
Department
Prior Authorization Department
Job Summary
The Prior Authorization Specialist is responsible for obtaining insurance authorizations and approvals for medical services, treatments, medications, procedures, and equipment. This role works closely with physicians, clinical staff, insurance companies, and patients to ensure timely approvals and accurate documentation while maintaining compliance with payer guidelines and company policies.
Essential Duties and Responsibilities
  • Submit prior authorization requests to insurance providers for medical services, medications, procedures, and treatments
  • Verify patient insurance eligibility and benefits
  • Review clinical documentation to ensure authorization requirements are met
  • Communicate with physicians, nurses, pharmacies, and other departments regarding authorization status and additional documentation needs
  • Follow up with insurance companies on pending, denied, or incomplete authorizations
  • Process authorization renewals and extensions as needed
  • Document all authorization activities accurately in the EMR/EHR system
  • Maintain knowledge of insurance payer guidelines, Medicare, Medicaid, and commercial insurance requirements
  • Assist with appeals and denial management when authorizations are denied
  • Ensure all approvals are obtained prior to scheduled services when required
  • Maintain confidentiality of patient information in compliance with HIPAA regulations
  • Provide excellent customer service to patients and internal staff
Qualifications
  • High school diploma or equivalent required; associate degree preferred
  • Minimum of 12 years of experience in healthcare, medical billing, insurance verification, or prior authorization preferred
  • Knowledge of medical terminology, CPT, ICD-10, and HCPCS coding preferred
  • Experience with EMR/EHR systems and insurance portals
  • Strong organizational and multitasking skills
  • Excellent communication and problem-solving abilities
  • Ability to work independently and in a fast-paced environment
  • Proficiency in Microsoft Office applications
Preferred Experience
  • Experience in Home Health, Hospice, Specialty Pharmacy, or Medical Office settings
  • Familiarity with Medicare, Medi-Cal/Medicaid, and commercial payer authorization processes
Physical Requirements
  • Prolonged periods of sitting and computer work
  • Ability to communicate effectively by phone and email
  • Occasional lifting of office materials up to 15 pounds
Work Environment
  • Office or healthcare setting
  • Standard business hours with occasional overtime depending on authorization volume
Skills
  • Attention to detail
  • Time management
  • Insurance verification and authorization processing
  • Data entry accuracy
  • Customer service
  • Team collaboration