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Medical Prior Authorization Jobs (NOW HIRING)

MC-Rx

Prior Authorization Coordinator

Gainesville, GA · 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 ...

MDxHealth

Prior Authorization Specialist

Irvine, CA · On-site

$19.26 - $23/hr

The Prior Authorization Specialist is responsible for all aspects of the prior authorization ... paid medical, dental, vision and life insurance coverage, 401(k) with company match, generous ...

Brown University Health

Prior Authorization Coord

Boston, MA · On-site

$19.03 - $31.39/hr

... and prior authorization processes for outpatient radiological services within Brown University ... Knowledge of business systems, office procedures, computer skills, medical terminology, and health ...

Hopedale MC

Prior Authorization Specialist

Hopedale, IL · On-site

$18 - $23/hr

HMC Wellness Center membership * 401(k) plan with employer match Job Preview The Prior Authorization Specialist is responsible for ensuring that payers are prepared to reimburse Hopedale Medical ...

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Medical Prior Authorization information

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$12

$22

$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.
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Medical Prior Authorization jobs near you
Prior Authorization Specialist

Prior Authorization Specialist

Advocate Aurora Health

Winston Salem, NC • On-site

$22.90 - $34.35/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 8 days ago

Advocate Aurora Health rating

7.6

Company rating: 7.6 out of 10

Based on 767 frontline employees who took The Breakroom Quiz

187th of 870 rated healthcare providers

Job description

Department:

12856 Wake Forest Baptist Medical Center - VP: Clinical Operations

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Monday-Friday, 8 hour days

Pay Range

$22.90 - $34.35

Job Summary: The incumbent for this position is responsible for doing follow-up for the SCORE Prior Authorization team. This position will be responsible for calling third-party insurance companies to check prior authorization status, checking third-party payor portal for prior authorization status, handling facsimiles related to prior authorization status, and scan correspondence into the patient's electronic medical record.

Education/Experience:

  • High school and two years' experience in third party payers, healthcare administrative support or general clerical experience.
  • Authorization process experience preferred.
  • Associate or bachelor's degree preferred.

Essential Functions:

  • Expedites sorting of surgical cases and checks status of prior authorization with shortest lead times.
  • Documents prior authorization activities appropriately and communicates necessary information to SCORE Prior Authorization team.
  • Evaluates processes, problem solving, and participates in departmental continuous improvement programs to enhance workflow processes and patient-centered outcomes.
  • Maintains a working knowledge of computer systems supported by the department.
  • Prioritizes and organizes daily work to ensure completion on time.
  • Maintains professional development.
  • Assists management in developing training materials.
  • Performs other duties as assigned.

Skills/Qualifications:

  • Strong oral and written communication skills
  • Ability to exercise independent judgment in unusual or stressful situations
  • Strong computer skills
  • Ability to establish and maintain effective working relationships

Work Environment:

  • This is a virtual and in-office position.
  • Subject to many interruptions
  • Operates keyboard, photocopier, telephone, and other office equipment
  • Work may be stressful at times
  • Occasionally subject to irregular hours

Our CommitmenttoYou:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

  • Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

  • Premium pay such as shift, on call, and more based on a teammate's job

  • Incentive pay for select positions

  • Opportunity for annual increases based on performance

Benefits and more

  • Paid Time Off programs

  • Health and welfare benefits such as medical, dental, vision, life, andShort- and Long-Term Disability

  • Flexible Spending Accounts for eligible health care and dependent care expenses

  • Family benefits such as adoption assistance and paid parental leave

  • Defined contribution retirement plans with employer match and other financial wellness programs

  • Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.


About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

What Advocate Aurora Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Advocate Health

Sourced by ZipRecruiter

Advocate Healthcare, based in Oak Lawn, Illinois, United States, is a leading figure in the health care industry. Accessible via their official website, 'advocatehealth.com', this organization provides a wide variety of medical services and treatment options. Founded in 1995 through a merger of Evangelical Health Systems Corporation and Lutheran General HealthSystem, Advocate Healthcare has grown exponentially over the years. Now, it operates more than 400 sites of care, including 12 hospitals that encompass 11 acute care hospitals, the state’s largest integrated children’s network, five Level I trauma centers, and three Level II trauma centers. Upholding their values of equality, compassion, excellence, partnership and stewardship, Advocate Healthcare's mission is centered on building lifelong relationships with patients by delivering the best health outcomes and highest level of service through an integrated approach to care and wellness.

Industry

Hospitals and health care and social assistance

Company size

10,000+ Employees

Headquarters location

Charlotte, NC, US

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