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How much do prior authorization representative express scripts jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for prior authorization representative express scripts in the United States is $18.05, according to ZipRecruiter salary data. Most workers in this role earn between $14.90 and $19.23 per hour, depending on experience, location, and employer.

What is a prior authorization representative Express Scripts?

A Prior Authorization Representative at Express Scripts is responsible for reviewing and processing medication prior authorization requests from healthcare providers and pharmacies. They assess requests based on insurance coverage policies, ensuring prescriptions meet clinical and formulary guidelines. The representative communicates approval or denial decisions and may collaborate with prescribers for additional information. Strong attention to detail, customer service skills, and knowledge of medical terminology are essential for success in this role.

What does a prior authorization representative Express Scripts do?

In this role, you will review and process prior authorization requests for prescription medications, ensuring that all necessary documentation and criteria are met. You’ll communicate frequently with healthcare providers, patients, and insurance companies to gather information, explain coverage decisions, and resolve any issues. Coordination with pharmacy teams and use of specialized software are also routine responsibilities. The position requires strong organizational skills and adaptability, as you will often manage multiple cases with varying priorities throughout your day.

What are the key skills and qualifications needed to thrive as a prior authorization representative Express Scripts?

To excel as a Prior Authorization Representative at Express Scripts, you need strong knowledge of pharmacy benefits, medical terminology, and insurance processes, often supported by experience in healthcare or pharmacy settings. Familiarity with prior authorization systems, insurance verification tools, and HIPAA compliance is important, and some employers may prefer a pharmacy technician certification. Exceptional communication, attention to detail, and problem-solving skills help representatives navigate patient and provider inquiries efficiently. These qualifications ensure timely and accurate processing of medication requests, helping patients access care while maintaining regulatory and company standards.

More about Prior Authorization Representative Express Scripts jobs
What are the most commonly searched types of Prior Authorization Representative Express Scripts jobs? The most popular types of Prior Authorization Representative Express Scripts jobs are:
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Prior Authorization Representative Express Scripts jobs near you
Infographic showing various Prior Authorization Representative Express Scripts job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $37,548 per year, or $18.1 per hour.

Customer Service / Prior Authorization Representative

Gryphon Healthcare

Houston, TX • On-site

$15.25 - $20.75/hr

Full-time

Medical

Posted 19 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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