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Medical Prior Authorization Jobs (NOW HIRING)

The Remedy

Prior Authorization Specialist

Saint Paul, MN · On-site

Organizes patient medical records for prior authorization and appeals processes as needed. Tracks and monitors the status of prior authorization requests and appeals, documenting updates in PM/EMR ...

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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 ...

Soleo Health, Inc.

$20 - $23/hr

Affordable Medical, Dental, & Vision Insurance Plans * Company Paid Disability & Basic Life ... The Prior Authorization Coordinator ensures seamless patient care by maintaining prior ...

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 ...

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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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How much do medical prior authorization jobs pay per hour?

As of Jul 1, 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

The Remedy Mental Health

Vadnais Heights, MN • On-site

$25 - $26/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

Job description

Job Summary:
At The Remedy, the Prior Authorization Specialist plays an integral role in the patient intake and revenue cycle process. This role will focus on the coordination and management of medication and treatment prior authorizations for a mental health organization, ensuring accuracy, timely submission, and alignment with payer guidelines to support uninterrupted patient care
This role leverages expertise in insurance verification and authorization processes to confirm benefits and eligibility, collect necessary documentation, and submit prior authorization requests to support timely and accurate reimbursement. This is an onsite position based in Vadnais Heights, MN.
Duties/Responsibilities
• Educates patients prior to appointments on their benefits, including differences between medical and behavioral health coverage, to support informed treatment decisions.
• Contacts payers to verify insurance benefits and eligibility for behavioral health services via online portals, eligibility systems, or direct communication.
• Ensures all benefit information is accurately documented to reduce rework and support clean claim submission.
• Requests and collects required clinical documentation from providers to support authorization approvals.
• Prepares and submits prior authorization requests to commercial and government payers.
• Organizes patient medical records for prior authorization and appeals processes as needed.
• Tracks and monitors the status of prior authorization requests and appeals, documenting updates in PM/EMR systems.
• Posts payer authorization decisions in a timely and accurate manner prior to services to ensure financial clearance, enhance patient experience, and support timely reimbursement.
• Identifies and reports payer trends or patterns impacting authorizations.
• Communicates proactively with patients to provide updates and address questions throughout the authorization process.
• Performs other duties as assigned.
• Serve as a liaison between providers, patients, and internal departments, facilitating clear communication to support accurate workflows and positive patient outcomes.
Required Skills/Abilities
• Excellent verbal and written communication skills.
• Strong interpersonal, negotiation, and conflict resolution skills.
• Exceptional organizational skills with strong attention to detail.
• Strong analytical and problem-solving abilities.
• Ability to prioritize tasks effectively.
• Demonstrated integrity, professionalism, and ability to maintain confidentiality.
• Proficiency in Microsoft Office Suite and healthcare systems (PM/EMR preferred).
Education and Experience
• High school diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration or related field preferred.
• 1-3 years of experience in prior authorization, insurance verification, or revenue cycle operations required.
• Experience working with behavioral health services strongly preferred.
• Familiarity with commercial and government payers (e.g., Medicare, Medicaid) required.
• Experience using PM/EMR systems and payer portals (e.g., Availity or similar) preferred
Physical Requirements:
• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.
The Remedy Mental Health offers a comprehensive benefits package and provides eligible employees with an opportunity to enroll in various benefit programs, subject to applicable waiting periods. This includes the following:
• Paid Time Off
• Holiday Pay
• Medical Insurance
• Health Savings Account
• Dental Insurance
• Vision Insurance
• 401(k) with Employer Match
• Life Insurance and AD&D
• Short-Term Disability
EEO Statement:
The Remedy Mental Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, or any other protected status.
Disclaimer:
This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the position. Duties may change based on business needs.
Work Authorization Requirement:
All candidates must be legally authorized to work in the United States. The company does not currently sponsor employment visas.

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