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Medical Prior Authorization Jobs (NOW HIRING)

Reliable Medical

Prior Authorization Specialist

Aurora, IL · On-site

$19.50 - $21.50/hr

Prior Authorization Specialist Since our doors opened in 1989, Reliable Medical has been committed to improving the lives of all who entrust us with their care and those who we entrust to provide it.

Tobii DynaVox

Prior Authorization Submitter

$20/hr

The Prior Authorization Submitter (PAS) works directly with insurance companies to request a review for medical necessity and prior authorization for durable medical equipment before providing ...

Foothills Neurology

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Prior Authorization Specialist

Phoenix, AZ · On-site

$20 - $25/hr

The Prior Authorization Specialist will handle all aspects of prior authorizations and referrals ... Review medical records to confirm insurance requirements are met. * Submit requests to insurance ...

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CareMed Specialty Pharmacy

$23 - $25/hr

Pharmacy Prior Authorization Specialist - CareMed Specialty Pharmacy Buffalo, NY | Full-Time | ... Medical; Dental; Vision * 401k with a match * Paid Time Off and Paid Holidays * Tuition ...

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Medical Prior Authorization information

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How much do medical prior authorization jobs pay per hour?

As of Jun 30, 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
What cities are hiring for Medical Prior Authorization jobs? Cities with the most Medical Prior Authorization job openings:
What states have the most Medical Prior Authorization jobs? States with the most job openings for Medical Prior Authorization jobs include:
Medical Prior Authorization jobs near you
Infographic showing various Medical Prior Authorization job openings in the United States as of June 2026, with employment types broken down into 77% Full Time, 16% Part Time, and 7% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $47,733 per year, or $22.9 per hour.

PRIOR AUTHORIZATION SPECIALIST

Graves Gilbert Clinic

Bowling Green, KY

$17.75 - $23.50/hr

Full-time

Posted 3 days ago

Graves Gilbert Clinic rating

6.6

Company rating: 6.6 out of 10

Based on 23 frontline employees who took The Breakroom Quiz

Job description

The Prior Authorization Specialist is responsible for verifying patient eligibility and insurance benefits for clinic-administered medications. This position requires a thorough understanding of insurance terminology, benefit structures, and authorization processes to ensure accurate documentation and timely completion of prior authorization requests. The Specialist will obtain, monitor, and maintain authorizations through payer websites, fax, and telephone, including all necessary follow-up and reauthorization activities. This role supports revenue cycle accuracy and contributes to the delivery of high-quality patient care.

Key Responsibilities:

  • Initiate, monitor, and secure prior authorizations from third-party payers.
  • Maintain electronic documentation for all prior authorization activities in accordance with organizational standards.
  • Track pending authorizations and follow up within defined timeframes (7–10 days or payer-specific requirements) to support timely claims submission.
  • Obtain authorization renewals and verify active provider orders and medical necessity documentation.
  • Work collaboratively with clinicians, practice managers, and other team members to obtain clinical notes and documentation necessary for prior authorization approval.
  • Verify authorization quantities and effective dates; ensure accurate processing by third-party payers and correct loading of information in internal systems.
  • Review and confirm patient eligibility, insurance benefits, and plan requirements for clinic-administered medications.
  • Interpret payer pre-certification and authorization guidelines and ensure appropriate approvals are obtained and documented.
  • Input accurate Payer Plan ID numbers and related data into organizational systems to ensure correct billing for current and future services.
  • Determine patient financial responsibility, including coordination of benefits and other coverage considerations.
  • Organize workload and manage deadlines to prevent delays or loss of revenue due to filing limitations.
  • Maintain professional communication with all payers, clinicians, and other team members.
  • Perform additional duties as assigned.

 Qualifications:

  • Prior experience in authorization processing and benefit investigation required.
  • Experience with specialty medication authorizations preferred.
  • Strong attention to detail and accuracy.
  • Excellent time management and organizational skills.
  • Proficiency in Microsoft Excel and related software applications.
  • Strong interpersonal and communication skills.
  • Ability to interpret insurance benefits, authorization guidelines, and medical terminology.
  • Ability to work collaboratively in a fast-paced, team-oriented environment.

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