ZipRecruiter

Log In

1

Prior Authorization Rep Jobs (NOW HIRING)

BJC HealthCare

Prior Authorization Rep Role

Saint Louis, MO · On-site

$17.75 - $25.56/hr

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 ...

Harmony Home Health

Authorization Representative

Murray, UT

$37.60K - $51.60K/yr

Authorization Representative We have an exciting opportunity for an Authorization Representative at ... Obtain prior authorization for services from clients' medical insurance carriers. Review client ...

TTI

Customer Service Rep II - Non-Exempt

Atlanta, GA · On-site

$15.50 - $21/hr

Prior Authorization Representative The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. Works directly with ...

IVX Health

Prior Authorization Coordinator

Brentwood, TN · On-site +1

$17.50 - $21.75/hr

Support Patients and Providers - Communicate effectively with patients, clinical staff, and insurance representatives regarding the Prior Authorization process. Ensure Compliance and Process ...

Hire Talent

Customer Service Rep II - Non-Exempt

Seymour, CT · On-site

$16 - $21.75/hr

Prior Authorization Representative The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. Works directly with ...

New

Hopedale MC

Prior Authorization Specialist

Hopedale, IL · On-site

$18 - $23/hr

The representative will contact payers to request service authorizations and may collect financial and/or demographic information from patients as needed. The Prior Authorization Specialist is also ...

next page

Showing results 1-20

People also search for

All JobsPrior Authorization Rep Jobs

Prior Authorization Rep information

See salary details

$24.5K

$44.2K

$77K

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.

More about Prior Authorization Rep jobs
What states have the most Prior Authorization Rep jobs? States with the most job openings for Prior Authorization Rep jobs include:
What job categories do people searching Prior Authorization Rep jobs look for? The top searched job categories for Prior Authorization Rep jobs are:
Prior Authorization Rep jobs near you
Prior Authorization Rep Sr

Prior Authorization Rep Sr

Hennepin Healthcare

Minneapolis, MN • Remote

Other

Posted 15 days ago

Hennepin Healthcare rating

7.6

Company rating: 7.6 out of 10

Based on 42 frontline employees who took The Breakroom Quiz

184th of 865 rated healthcare providers

Job description

JOB DETAILS
Department: Financial Securing
FTE: 1.00 (80 hours per pay period)
Workdays: Monday - Friday
Shift(s): Days
Shift Length: 8 hours
Location: Remote*

*Current List of non-MN States where Hennepin Healthcare is an Eligible Employer: Alabama, Arizona, Arkansas, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Mississippi, Nevada, North Carolina, North Dakota, New Mexico, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin.

Purpose of this position: The Prior Authorization Specialist plays a key role in the patient financial experience by coordinating pre-authorizations for patients and often handling cases that need quick turnaround (e.g., last-minute scheduled services). The individual in this role is an expert on payer regulations and contracts, and they serve as a point of contact for peers looking to resolve questions or issues regarding prior authorizations

RESPONSIBILITIES

  • Utilizes online systems, phone communication, and other resources to secure prior authorizations within a timeframe before scheduled appointments/procedures/same day surgeries and during or after care for unscheduled patients
  • Verifies medical necessity in accordance with the Centers for Medicare & Medicaid Services (CMS) standards and communicates relevant coverage/eligibility information to the provider/patient, as it pertains to prior authorization
  • Coordinates benefits by effectively determining primary, secondary, and tertiary liability when needed
  • Obtains pre-certifications and prior authorizations from third-party payers in accordance with payer requirements
  • Alerts physician offices to issues with verifying insurance and/or obtaining prior authorizations
  • Demonstrates expert understanding of insurance terminology (e.g., co-payments, deductibles, allowances, etc.), and analyzes information received to determine patients' out-of-pocket liabilities, based on prior authorization status
  • Follows up on all prior authorization submissions for timely response
  • Follows up on any prior authorization denials; assists Utilization Management with appeals, as needed
  • Connects patients with financial counselors, as necessary
  • Maintains productivity and quality standards and assists other team members when necessary
  • Participates in developing and planning process improvements for the department
  • Other duties as assigned
  • Complies with all state and federal laws and regulations related to patient privacy and confidentiality

QUALIFICATIONS
Minimum Qualifications:

  • High school diploma or equivalent
  • 2 years clerical experience in health care revenue cycle operations: billing/claims, patient accounting, collections, admissions, registration, etc. 
  • Bilingual strongly preferred, required in some positions 

-OR-

  • An approved equivalent combination of education and experience

Preferred Qualifications:

  • Experience working in EPIC, preferred

Knowledge/ Skills/ Abilities:

  • Requires knowledge of government and commercial payer (Insurance) benefit and eligibility verification, and ability to become aware of and navigate medical policy per payer guidelines
  • Demonstrated expertise in logical thinking, data preparation, and analysis
  • Comprehensive knowledge of Microsoft Office (Outlook, Word, Excel)
  • Strong communication skills, both verbal and written
  • Ability to communicate effectively with collaborating departments, providers, and insurance representatives
  • Demonstrated organizational skills and the ability to prioritize and manage tasks based on established criteria
  • Excellent verbal and written communication and interpersonal skills
  • Ability to work independently with minimal supervision, within a team setting and be supportive of team members
  • Proficient with Microsoft Office
  • Ability to analyze issues and make judgments about appropriate steps toward solutions

What Hennepin Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply