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Prior Authorization Rep Jobs in Texas (NOW HIRING)

Medix

Prior Authorization Pharmacy Technician

Plano, TX · On-site

$23 - $26/hr

The actual posting represents a position at one of our clients. Job Summary Our client is seeking a skilled Prior Authorization Specialist to join their team. The primary responsibility of this role ...

New England Baptist Hospital

TX · On-site

$15.25 - $19.50/hr

Verifies insurance coverage. 3. Prior Authorization Obtains prior authorization for any for any upcoming procedures requiring an authorization in a timely manner Maintains thorough knowledge of all ...

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All JobsPrior Authorization Rep JobsPrior Authorization Rep Jobs in Texas

Prior Authorization Rep information

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 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.

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.

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 are popular job titles related to Prior Authorization Rep jobs in Texas? For Prior Authorization Rep jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Prior Authorization Rep jobs in Texas look for? The top searched job categories for Prior Authorization Rep jobs in Texas are:
Prior Authorization Rep jobs near you
Infographic showing various Prior Authorization Rep job openings in Texas as of July 2026, with employment types broken down into 1% As Needed, 86% Full Time, 11% Part Time, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.
Customer Service / Prior Authorization Representative

Customer Service / Prior Authorization Representative

Gryphon Healthcare

Houston, TX

$15.25 - $20.75/hr

Full-time

Medical

Posted 4 days ago

Job description

Customer Service / Prior Authorization Representative
We are seeking an enthusiastic and detail-oriented Customer Service / Prior Authorization Representative to join our team. In this role, you will serve as the first point of contact for our patients while also managing prior authorization requests to help ensure timely access to care.
The ideal candidate will have prior authorization experience in a medical setting, with Radiology experience strongly preferred. You will work closely with our client medical offices, insurance carriers, and internal teams to obtain authorizations, verify benefits, resolve patient inquiries, and support the Medical Records Department.
The Ideal Candidate Will Have:
  • Previous prior authorization experience is required – Minimal 1 year experience required
  • Radiology prior authorization experience is strongly preferred
  • Experience with medical insurance verification
  • Knowledge of commercial insurance plans, Medicare, and Medicaid
  • Ability to interpret Explanation of Benefits (EOBs)
  • Strong attention to detail and accurate data entry skills
  • Excellent communication and customer service skills
  • Previous call center or high-volume patient service experience
  • A passion for helping patients and providing exceptional customer service
If you thrive in a fast-paced healthcare environment and enjoy helping patients while ensuring timely authorization of medical services, we encourage you to apply!
Job Description – Customer Service / Prior Authorization Representative
Location: Houston, TX 77041
Job Summary
The Customer Service / Prior Authorization Representative is responsible for responding to patient account inquiries, obtaining and managing insurance prior authorizations, verifying insurance eligibility and benefits, processing patient payments, generating patient statements, and assisting with medical records requests. This position works closely with providers, insurance companies, and patients to ensure services are authorized and patient billing questions are resolved accurately and efficiently.
Duties and Responsibilities
  • Answer incoming calls from patients and customers, identifying the type of assistance needed.
  • Obtain, submit, monitor, and document insurance prior authorizations for medical services and procedures.
  • Verify insurance eligibility, benefits, authorization requirements, and referral requirements.
  • Follow up with insurance carriers regarding pending or denied authorizations and appeals as appropriate.
  • Coordinate with physician offices, scheduling staff, and clinical personnel to obtain required documentation for authorization requests.
  • Ask appropriate questions and actively listen to identify customer concerns while accurately documenting information in company systems.
  • Research patient accounts and healthcare claims using multiple computer systems.
  • Ensure appropriate insurance benefits are applied to each patient account.
  • Resolve patient billing questions using clear, professional communication.
  • Process patient payments and generate patient statements.
  • Assist the Medical Records Department by retrieving records for patients, attorneys, and third-party vendors.
  • Meet established performance goals for quality, productivity, customer satisfaction, accuracy, and attendance.
  • Demonstrate excellence in customer service with every patient interaction.
  • Participate in continuing education to remain current on medical billing, insurance regulations, and prior authorization requirements.
  • Support other members of the Revenue Cycle team as needed.
  • Perform other duties as assigned.
Competencies
  • Customer Service
  • Problem Solving
  • Analytical Thinking
  • Attention to Detail
  • Technical Skills
  • Oral Communication
  • Written Communication
  • Teamwork
  • Organization and Time Management
  • Ethics and Confidentiality
  • Adaptability
Education Requirements
  • High School Diploma or equivalent required.
Experience Requirements
  • Minimum of one (1) year of customer service experience in a medical office, clinic, hospital, emergency room, or healthcare setting.
  • Minimum of one (1) year of prior authorization experience required.
  • Radiology prior authorization experience strongly preferred.
  • Medical billing and insurance verification experience preferred.
Special Knowledge, Skills, and Abilities Required
  • Knowledge of insurance prior authorization processes and payer requirements.
  • Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans.
  • Knowledge of medical billing and collection practices.
  • Ability to interpret Explanation of Benefits (EOBs).
  • Familiarity with EMR/EHR systems, EDI, and insurance portals.
  • Understanding of HIPAA regulations and patient confidentiality requirements.
  • Strong organizational, follow-up, and time management skills.
  • Excellent verbal and written communication skills.
  • Ability to multitask and prioritize in a fast-paced environment.
  • Detail-oriented with accurate data entry skills.
  • Proficiency with Microsoft Outlook and Windows-based computer systems.
  • Bilingual (English/Spanish) is a plus but not required.
Working Environment
Ability to work in a fast-paced, high-volume healthcare environment. Must be able to manage multiple priorities while maintaining accuracy and excellent customer service. Flexibility to work additional hours as needed to meet business demands.

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