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Prior Authorization Analyst Jobs (NOW HIRING)

3Y

Prior Authorization Lead

New York, NY · On-site

$100K - $140K/yr

About the Role We are seeking a Prior Authorizations Lead to design, manage, and scale 3Y Health ... Analytical and systems-oriented thinker with a track record of driving measurable improvements in ...

Cencora

Prior Authorization Coordinator

Reading, PA

$18 - $23.50/hr

Job Details The Prior Authorization Coordinator is a pharmacy technician who will act as onsite ... Good analytical skills. * Commitment to maintaining patient confidentiality and privacy.

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Prior Authorization Analyst information

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How much do prior authorization analyst jobs pay per year?

As of Aug 11, 2026, the average yearly pay for prior authorization analyst in the United States is $73,261.00, according to ZipRecruiter salary data. Most workers in this role earn between $52,500.00 and $87,000.00 per year, depending on experience, location, and employer.

What is the difference between Prior Authorization Analyst vs Claims Processor?

AspectPrior Authorization AnalystClaims Processor
Required CredentialsTypically requires healthcare-related certifications or knowledge, such as CPC or medical billing experienceOften requires basic billing or coding certifications, less specialized
Work EnvironmentHealthcare offices, insurance companies, or hospital settingsInsurance companies, healthcare providers, or billing departments
Employer & Industry UsageUsed in health insurance, hospitals, and healthcare organizationsCommon in insurance companies and healthcare billing departments
Search & Comparison IntentPeople compare to understand roles involving prior authorization and approvalsPeople compare to understand claims processing and reimbursement tasks

The Prior Authorization Analyst focuses on obtaining approvals for medical services before treatment, requiring specialized healthcare knowledge. In contrast, Claims Processors handle billing and reimbursement after services are provided. While both roles are essential in healthcare administration, they differ in responsibilities, credentials, and work environments.

What are some common challenges faced by prior authorization analysts and how can they be effectively addressed?

Prior Authorization Analysts often face challenges such as managing high volumes of authorization requests, staying updated with frequently changing insurance policies, and ensuring timely communication between providers, patients, and payers. To address these challenges, it's important to stay organized, leverage technology tools for tracking requests, and participate in regular training sessions on policy updates. Building strong relationships with both clinical and administrative teams can also help streamline the authorization process and resolve issues quickly.

What are the key skills and qualifications needed to thrive as a prior authorization analyst?

To thrive as a Prior Authorization Analyst, you need a solid understanding of medical terminology, insurance policies, and healthcare regulations, often supported by a healthcare-related degree or relevant experience. Familiarity with prior authorization software, electronic health record (EHR) systems, and payer portals is essential. Attention to detail, problem-solving abilities, and strong communication skills set top performers apart in this role. These competencies ensure timely and accurate processing of authorizations, reducing delays in patient care and maintaining compliance with payer requirements.

What does a prior authorization analyst do?

A Prior Authorization Analyst is responsible for reviewing and processing requests for medical procedures, prescriptions, or services that require approval from insurance providers before they are carried out. They evaluate clinical documentation, verify eligibility, and ensure that requests meet the payer’s guidelines and criteria. Their work helps control healthcare costs and ensures patients receive appropriate care that is covered by their insurance plan.
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What are the most commonly searched types of Prior Authorization Analyst jobs? The most popular types of Prior Authorization Analyst jobs are:
What job categories do people searching Prior Authorization Analyst jobs look for? The top searched job categories for Prior Authorization Analyst jobs are:
Prior Authorization Analyst jobs near you
Infographic showing various Prior Authorization Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $73,261 per year, or $35.2 per hour.

UM Authorization Analyst 2 Bilingual

The Oncology Institute of Hope and Innovation

Tampa, FL • Remote

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

About The Oncology Institute (www.theoncologyinstitute.com):
Founded in 2007, The Oncology Institute (NASDAQ: TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI offers cutting-edge, evidence-based cancer care to a population of approximately 1.9 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With over 180 employed and affiliate clinicians and over 100 clinics and affiliate locations of care across five states and growing, TOI is changing oncology for the better.

Join a team where your clinical insight directly shapes patient outcomes and care quality. As a UM Authorization Analyst II, you'll play a critical role in ensuring timely, evidence-based decisions that support both patients and providers—while working in a collaborative environment that values accuracy, efficiency, and professional growth.

JOB PURPOSE AND SUMMARY:

The UM Authorization Analyst II is responsible for ensuring the timely and accurate processing of medical procedure authorizations. This role includes reviewing authorization requests, maintaining compliance with regulations, and coordinating with healthcare providers and insurance companies to support patient care.

This role can be worked remotely from anywhere in the contiguous United States, and will be working on an Eastern time schedule.

ESSENTIAL DUTIES AND RESPONSBILITIES:

  • Leading daily huddles with UM Physician Reviewers to address risks related to timely decision-making and documentation accuracy.
  • Creating, reviewing, and administering corrective action forms with support and guidance from the Director, Utilization Management Compliance.
  • Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance.
  • Working closely with the Director, Utilization Management Compliance to identify deficiencies and areas for improvement.
  • Partnering with delegated entities to ensure the accuracy and compliance of provider credentialing processes, conducting thorough sanction and exclusion checks, and promoting the effective utilization of QuickCap workflows within Utilization Management operations.
  • Reporting and Analysis: prepare and present regular reports on authorization activities, including volume, turnaround times, and issues.
  • Identifying and forwarding standard or expedited appeals to the appropriate health plan.
  • Staying current on industry regulations, guidelines, and best practices related to utilization management and review.
  • Participating in monitoring and analyzing Inter-Rater Reliability (IRR) testing, identifying trends, and recommending best practice improvements to consistent decision-making.
  • Demonstrating expertise in health plan delegation requirements, including Preparation and submission of reports, participate in implementation of corrective action plans (CAPs), updates to policies and procedures, and monitoring and applying regulatory changes to maintain contractual compliance.
  • Ensuring adherence to key performance indicators (KPIs) and service level agreements (SLAs) for all delegated Utilization Management (UM) functions.
  • Performing other duties as assigned to support operational goals.
  • Living and exemplify TOI core values, providing outstanding customer service and promoting a positive experience for patients and staff members.

KNOWLEDGE, SKILLS, AND ABILITIES:

  • Excellent communication and interpersonal skills.
  • In-depth knowledge of medical procedure authorization processes and healthcare insurance requirements.
  • Ability to analyze data and implement process improvements.
  • Proficiency with medical billing software and electronic health records (EHR) systems.
  • Strong organizational skills and attention to detail.
  • Strong understanding of evidence-based guidelines (MCG, National Coverage Determinations, Local Coverage Determinations).
  • Understanding of prior authorization regulatory requirements and turnaround time expectations (CMS, AHCA, NCQA, URAC).

REQUIRED EXPERIENCE, EDUCATION AND/OR TRAINING:

  • Associate's degree in health information management, or a healthcare related field. Bachelor's preferred.
  • 4-6 years of experience in utilization management.
  • Bilingual in English and Spanish required.

PHYSICAL WORKING REQUIREMENTS:

The position involves prolonged periods of sitting at a desk, extensive computer use, and phone interaction. Additionally, the role may require occasional lifting of up to 20 pounds for office supplies or equipment.

The physical demands described above are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role.

Pay Transparency for salaried teammates
$71,000—$85,000 USD