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Prior Authorization Rep Jobs (NOW HIRING)

BJC

Prior Authorization Rep

Saint Louis, MO

$38.90K - $53.50K/yr

Prior Authorization Representative Sunset Hills is looking to hire a Prior Authorization Rep! This Role will be located at 3630 S. Geyer Road Sunset Hills, MO. Additional Preferred Requirements: * 8 ...

Quadax, Inc.

Prior Authorization Representative

Cleveland, OH · On-site

$38.80K - $53.40K/yr

Navigate through payer portals to initiate/obtain prior authorization status. * Provide insurance company representatives with an overview of the services being submitted for prior authorization.

Managed Staffing

Prior Authorization Representative

AL · Remote

$17.50 - $18.50/hr

Prior Authorization Technician Location: Fully Remote (Work from Home - Anywhere in the U.S.) Pay Rate: $17.90/hour (W2) Schedule: Monday-Friday, 8-hour shifts between 8:00 AM-8:00 PM CT Training ...

BJC HealthCare

Prior Authorization Rep

Saint Louis, MO · On-site

$17.75 - $25.56/hr

Additional Information About the Role Sunset Hills is looking to hire a Prior Authorization Rep! This Role will be located at 3630 S. Geyer Road Sunset Hills Mo. Additional Preferred Requirements * 8 ...

BJC HealthCare

Prior Authorization Rep

Saint Louis, MO · On-site

$36.20K - $49.80K/yr

Additional Information About the Role Sunset Hills is looking to hire a Prior Authorization Rep! This Role will be located at 3630 S. Geyer Road Sunset Hills Mo. Additional Preferred Requirements * 8 ...

BJC

Prior Authorization Rep Role

Saint Louis, MO · On-site

$38.90K - $53.50K/yr

Prior Authorization Representative BJC is looking to hire a Prior Authorization Rep for their Sunset Hills Infusion Location located off Geyer RD. The role involves verifying insurance, obtaining ...

BJC

Prior Authorization Rep - Part Time

Belleville, IL

$38.90K - $53.40K/yr

Part Time Prior Auth Rep Memorial Hospital is looking for a Part Time Prior Auth Rep for their ... Job duties include patient registration, handling surgery prior authorizations, scheduling ...

BJC HealthCare

Prior Authorization Rep Role

Saint Louis, MO · On-site

$38.90K - $53.50K/yr

Additional Information About the Role BJC is looking to hire a Prior Authorization Rep for their Sunset Hills Infusion Location located of off Geyer RD. Additional Preferred Requirements * Sunset ...

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How much do prior authorization rep jobs pay per year?

As of Jun 4, 2026, the average yearly pay for prior authorization rep in the United States is $44,219.00, according to ZipRecruiter salary data. Most workers in this role earn between $37,500.00 and $43,000.00 per year, depending on experience, location, and employer.

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

To thrive as a Prior Authorization Rep, you need knowledge of healthcare insurance processes, medical terminology, and a high school diploma or equivalent, with some employers preferring additional healthcare certifications. Familiarity with insurance portals, electronic medical record (EMR) systems, and claims management software is typically required. Attention to detail, strong organizational skills, and effective communication are essential soft skills for this role. These abilities enable accurate processing of authorizations, minimize delays for patient care, and ensure compliance with payer requirements.

How does a Prior Authorization Rep typically collaborate with healthcare providers and insurance companies to resolve authorization issues?

A Prior Authorization Rep serves as a key liaison between healthcare providers, patients, and insurance companies. They regularly communicate with physicians' offices to collect necessary clinical information, and then work closely with insurance representatives to ensure all documentation meets policy requirements. When issues or denials arise, Prior Authorization Reps must problem-solve quickly, often clarifying details or appealing insurance decisions. This collaborative process requires strong communication skills, attention to detail, and the ability to manage multiple cases simultaneously.

What does a Prior Authorization Representative do?

A Prior Authorization Representative is responsible for obtaining approval from insurance companies before certain medical procedures, medications, or treatments are provided to patients. They review clinical information, communicate with healthcare providers, and submit necessary documentation to payers to ensure services are covered. Their work helps prevent unexpected costs for patients and ensures compliance with insurance requirements. This role requires strong communication, attention to detail, and knowledge of healthcare processes.

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

AspectPrior Authorization RepMedical Billing Specialist
CredentialsHigh school diploma; certifications like NCICS or AHIMA preferredHigh school diploma; certifications like CPC or CCS beneficial
Work EnvironmentHealthcare offices, insurance companies, hospitalsMedical offices, billing companies, healthcare facilities
Primary ResponsibilitiesSecuring insurance approvals for procedures and treatmentsProcessing and submitting medical claims, coding, and billing

The Prior Authorization Rep focuses on obtaining insurance approvals before procedures, while the Medical Billing Specialist handles billing and claims processing after services are rendered. Both roles require healthcare knowledge and often work in similar environments, but their core tasks differ significantly.

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What states have the most Prior Authorization Rep jobs? States with the most job openings for Prior Authorization Rep jobs include:
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Prior Authorization Rep jobs near you
Prior Authorization Rep

Prior Authorization Rep

Arizona Priority Care

Chandler, AZ • Hybrid

$20 - $23/hr

Full-time

Medical

Posted 13 days ago

Job description

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 13 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Prior Authorization Representative I is responsible for processing incoming requests including verifying eligibility and benefits and the data entry component of the prior authorization request. The PA Rep I works closely with all UM Staff, Prior Auth Supervisor, and management to maintain turnaround time requirements of the contracted health plan, regulatory bodies, and internal goals. Routinely interacts with physicians, their office staff and internal customers.

POSITION DUTIES & RESPONSIBILITIES

  • Assist in managing the incoming prior authorization request by following work direction given by the Prior Authorization management to ensure Routine/Standard and Urgent/Expedited prior authorizations are processed in the appropriate amount of time and in compliance with regulatory and health plan requirements.
  • Complete a minimum data entry or adjudication of 40 authorizations per day.
  • Assist in reviewing and distributing incoming prior authorization requests including identifying Urgent/Expedited vs Routine/Standard, verifying member eligibility, delegated vs non-delegated services, retro vs. future date of services, accuracy checking documentation, and routing to appropriate folder.
  • Perform data entry of prior authorization requests with a minimum of 97% accuracy including primary insurance or hospice verification, determine if requested services require prior authorization, and confirm request is not duplicative.
  • Perform adjudication of authorization requests with a minimum of 97% accuracy including quality checking data entry, reviewing historical utilization management history to include program enrollment and verifying if rendering provider and facility is contracted, any tasks related to processing a prior authorization request (provider loads, out of network (OON) credentialing, accreditation verification, etc.), providing redirect information for OON requests, and routing to the appropriate queue or vendor.
  • Contact the provider's office for additional information per CMS and AZPC policies and guidelines.
  • Make expedited determination notifications to member and provider.
  • Provide exceptional, courteous, and professional phone customer service.
  • Educate practitioners as needed with the Authorization/Referral process.
  • Perform as necessary accommodate to departmental change, workload and emergencies.
  • Maintain current knowledge of CMS and NCQA standards, and AZPC UM Policies and procedures.
  • Protect privacy for patients, providers, and employees; ensure all personal health information is kept confidential.
  • Demonstrate caring, empathy, patience, respect and compassion for all team members.
  • Demonstrate honesty and integrity in everyday activities.
  • Perform other duties as directed by management.

EDUCATION, TRAINING AND EXPERIENCE

  • Highschool Diploma or GED – Required.
  • Minimum of 1-year administrative healthcare related experience – Required.
  • Proficient knowledge of medical terminology, CPT-4, HCPCS, and ICD-10 – Required.
  • Working knowledge of computer applications, such as Microsoft Office applications.
  • Excellent oral and written communication skills.
  • Demonstrated ability to be detail-oriented and multi-task effectively.
  • Able to interact effectively with all levels of staff.

Pay Range: $20.00 – $23.00/hour

*This role requires 60 days FT in office presence, hybrid options will be available after the 60-day period.*