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Prior Authorization Consultant Jobs (NOW HIRING)

SGS Consulting

Tech I - Prior Authorization

Richardson, TX · On-site

$16 - $19.25/hr

This position takes in-coming calls from members, providers, etc. providing professional phone assistance to all callers through the criteria based prior authorization process. * Maintains complete ...

SGS Consulting

Tech I - Prior Authorization

Richardson, TX

$16 - $19.25/hr

This position takes in-coming calls from members, providers, etc. providing professional phone assistance to all callers through the criteria based prior authorization process. * Maintains complete ...

W3R

RN Prior Authorization

Austin, TX

Operating out of 5 states currently, and expanding our consultant and client base daily, we realize building relationships are critical to the success of w3r. We value our relationships with our ...

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Prior Authorization Consultant information

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

AspectPrior Authorization ConsultantMedical Billing Specialist
CredentialsCertifications like CPC, CCS, or specialized prior authorization trainingMedical billing certifications, CPC, or CPC-H
Work EnvironmentHealthcare providers, insurance companies, or consulting firmsMedical offices, hospitals, billing companies
Employer & Industry UsageUsed in healthcare insurance and provider organizationsCommon in healthcare facilities handling billing processes

While both roles involve healthcare administration, a Prior Authorization Consultant focuses on obtaining approvals for treatments and services, whereas a Medical Billing Specialist manages billing and coding processes. The roles often overlap in credentials and work environments, but their primary functions differ in scope and responsibilities.

How much does a prior authorization specialist make in the US?

A prior authorization specialist in the US typically earns between $40,000 and $55,000 annually, depending on experience, location, and employer. Salaries can vary based on certifications, such as Certified Medical Reimbursement Specialist (CMRS), and the complexity of the healthcare setting. Many roles also offer benefits like health insurance and paid time off.

What skills do you need to be a prior authorization specialist?

A prior authorization specialist needs strong communication and organizational skills to manage documentation and coordinate with healthcare providers and insurance companies. Attention to detail, knowledge of medical terminology, and familiarity with electronic health record (EHR) systems are also important for efficiently processing authorizations and ensuring compliance.

How to become a prior authorization specialist?

To become a prior authorization specialist, candidates typically need a high school diploma or equivalent, along with knowledge of medical billing and coding. Relevant skills include attention to detail, communication, and familiarity with insurance policies and electronic health record systems. Certification in medical billing or coding can enhance job prospects and demonstrate expertise.

Is prior authorization a stressful job?

Prior Authorization Consultants often work in fast-paced healthcare environments, managing complex documentation and strict deadlines, which can contribute to job stress. The role requires attention to detail, communication skills, and familiarity with insurance policies, but stress levels vary depending on workload and support systems.
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Prior Authorization Consultant jobs near you
Infographic showing various Prior Authorization Consultant job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 88% Full Time, 10% Part Time, and 1% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.
RN Prior Authorization

RN Prior Authorization

Healthcare Support Staffing

Waltham, MA

$30/hr

Full-time

Medical, Dental, Vision

Posted 24 days ago

Job description

Company Description

Why You Should Work For Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Are you an experienced RN Prior Authorization looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!

Daily Responsibilities:  

Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.

Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations

Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings

Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care

Educate providers on utilization and medical management processes


Hours for this Position:

Monday- Friday; 8AM-5PM

Pay rate starts at $30 per hour


Advantages of this Opportunity: 

Competitive salary, negotiable based on relevant experience

Benefits offered, Medical, Dental, and Vision

Fun and positive work environment


Qualifications

RN licensure

Candidates must have a car- mass transportation in Boston doesn't go to Waltham

2+ years of clinical nursing experience

Some sort of Prior Authorization experience from either another managed care company or clinical setting


Additional Information

Interested in being considered? 

If you are interested in applying to this position, please contact (Katleen Angala, 321-445-8243) and click the Green I'm Interested Button to email your resume. 


Healthcare Support logo

About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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