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How much do prior authorization associate jobs pay per hour?

As of Jul 20, 2026, the average hourly pay for prior authorization associate in the United States is $19.01, according to ZipRecruiter salary data. Most workers in this role earn between $15.14 and $20.19 per hour, depending on experience, location, and employer.

What is the difference between Prior Authorization Associate vs Medical Billing Specialist?

AspectPrior Authorization AssociateMedical Billing Specialist
CredentialsHigh school diploma or equivalent; certification in medical billing or coding often preferredHigh school diploma or equivalent; certification in medical billing or coding often preferred
Work EnvironmentHealthcare offices, insurance companies, hospitalsHealthcare offices, billing companies, hospitals
Primary ResponsibilitiesObtain prior authorizations from insurance for procedures and treatmentsProcess and submit medical claims, handle billing and payments

The main difference is that a Prior Authorization Associate focuses on securing insurance approvals before procedures, while a Medical Billing Specialist manages the billing process after services are rendered. Both roles require similar credentials and often work in healthcare settings, but their core functions differ in the patient care and revenue cycle process.

What are the key skills and qualifications needed to thrive as a Prior Authorization Associate, and why are they important?

To thrive as a Prior Authorization Associate, you need a strong understanding of medical terminology, insurance processes, and prior authorization requirements, often backed by a high school diploma or associate degree. Familiarity with healthcare management software, electronic health record (EHR) systems, and payer portals is typically required. Excellent attention to detail, organizational skills, and effective communication are essential soft skills for this role. These skills ensure timely and accurate processing of prior authorizations, minimizing delays in patient care and supporting efficient healthcare operations.

What are Prior Authorization Associates?

Prior Authorization Associates are professionals who handle the process of obtaining approval from insurance companies before certain medical services, procedures, or medications are provided to patients. They review clinical documentation, communicate with healthcare providers and insurers, and ensure all necessary information is submitted for timely authorization. Their work helps reduce claim denials and ensures patients receive the care they need while adhering to insurance requirements.

What are some common challenges faced by a Prior Authorization Associate, and how can they be effectively managed?

Prior Authorization Associates often encounter challenges such as navigating complex insurance requirements, handling high volumes of authorization requests, and managing tight turnaround times. Staying organized, keeping up-to-date with payer policies, and using robust tracking systems can help manage these difficulties. Collaborating closely with clinical staff and insurance representatives is also essential for resolving issues quickly and ensuring approvals are processed efficiently. Developing strong communication and problem-solving skills is key to success in this role.
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Prior Authorization Associate jobs near you
Prior Authorization Associate

Prior Authorization Associate

Lexington Medical Center

Columbia, SC • On-site

$17 - $21.25/hr

Other

Medical, Dental, Life, Retirement

Re-posted 4 days ago

Lexington Medical Center rating

6.9

Company rating: 6.9 out of 10

Based on 104 frontline employees who took The Breakroom Quiz

534th of 1,020 rated hospitals

Job description

 
PN Access and Authorizations
Full Time
Day Shift
M-F 8a-5p

Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcare and was first in the state to achieve Magnet with Distinction status for excellence in nursing care. Consistently ranked as best in the Columbia Metro area by U.S. News & World Report, Lexington Health delivers more than 4,000 babies each year, performs more than 34,000 surgeries annually and is the region's third largest employer.

Lexington Health also includes an accredited Cancer Center of Excellence, the state's first HeartCARE Center, the largest skilled nursing facility in the Carolinas, and an Alzheimer's care center. Its postgraduate medical education programs include family medicine and transitional year residencies, as well as an informatics fellowship.

Job Summary

Responsible for accurately authorizing referrals prior to patient appointments. Utilizes Epic Referral Work Queues, Experian Real Time Authorization (RTA), phone, payer websites and fax to complete prior authorizations for imaging and specialty services. Communicates authorization updates to appropriate departments. Verifies all pertinent clinical information is submitted in order for authorization to be processed accurately. Documents all information within the referral record and chart in Epic to include approvals, denials, peer-to-peers and pending authorizations.

Minimum Qualifications

Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 6 months of referral and/or authorization experience
Substitutable Education & Experience: None.
Required Certifications/Licensure: None.
Required Training: Strong Medical Terminology and Insurance Knowledge; Knowledge of ICD-10 and CPT Coding

Essential Functions
  • Understands the referral process start to finish and acknowledges authorization as an important step in the overall process.
  • Meets authorization volume and quality standards set monthly. 
  • Thoroughly reviews patient charts in Epic, submits the appropriate clinicals for authorization to the correct payer/third party vendor, obtains final determination from payer and enters information into EPIC. 
  • Utilizes Experian RTA system to obtain authorization and verifies authorization completion within system.
  • Communicates all necessary authorization updates and status changes to the appropriate department(s).
  • Communicates peer-to-peer requests to PN practices for providers/clinical staff to complete in order to obtain an authorization from payer.
Duties & Responsibilities
  • Partners with LMC departments and insurance companies to provide quality care to LMC patients through the authorization process prior to patients' date of service.
  • Escalates difficult issues, problems, questions and process improvement suggestions to management.
  • Works with team to ensure timely process of authorizations. Participates in team problem solving activities, focuses on production and quality.
  • Performs other duties as assigned.

We are committed to offering quality, cost-effective benefits choices for our employees and their families:

  • Day ONE medical, dental and life insurance benefits 
  • Health care and dependent care flexible spending accounts (FSAs)
  • Employees are eligible for enrollment into the 403(b) match plan day one.  LHI matches dollar for dollar up to 6%.
  • Employer paid life insurance - equal to 1x salary
  • Employee may elect supplemental life insurance with low cost premiums up to 3x salary 
  • Adoption assistance
  • LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
  • Tuition reimbursement
  • Student loan forgiveness

Equal Opportunity Employer
It is the policy of Lexington Health to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. Lexington Health strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. Lexington Health endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee's desires and abilities and the hospital's needs.

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