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Prior Authorization Representative Jobs in Tennessee

Cardinal Health

Reimbursement Solutions Analyst

Oak Ridge, TN

$27/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Extensive contact with insurance companies to include speaking to representatives for benefit investigation as well as clinical clearance for prior authorization and medical necessity * Extensive ...

Cigna

Chief Medical Officer, Evernorth

Franklin, TN

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

The CMO will also serve as an external-facing clinical leader, representing Evernorth to clients ... Clinical Operations Oversight and Prior Authorization Transformation * Partner with internal teams ...

New

Sonic Healthcare USA

Referral Processor

Memphis, TN · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

In all communications especially when answering the phone, keep in mind you always represent the ... and PRIOR authorization holds that require insurance authorization prior to sending sample for ...

Honorhealth

Obtains prior authorization in order to avoid non-compliance, denials and/or penalties to the patient, hospital and physician(s). Initiates notifications to insurances as required. Checks for medical ...

Honorhealth

Obtains prior authorization in order to avoid non-compliance, denials and/or penalties to the patient, hospital and physician(s). Initiates notifications to insurances as required. Checks for medical ...

Honorhealth

Obtains prior authorization in order to avoid non-compliance, denials and/or penalties to the patient, hospital and physician(s). Initiates notifications to insurances as required. Checks for medical ...

Sonic Healthcare USA

Referral Processor

Memphis, TN

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

In all communications especially when answering the phone, keep in mind you always represent the ... and PRIOR authorization holds that require insurance authorization prior to sending sample for ...

Honorhealth

Obtains prior authorization in order to avoid non-compliance, denials and/or penalties to the patient, hospital and physician(s). Initiates notifications to insurances as required. Checks for medical ...

Honorhealth

Obtains prior authorization in order to avoid non-compliance, denials and/or penalties to the patient, hospital and physician(s). Initiates notifications to insurances as required. Checks for medical ...

Honorhealth

Obtains prior authorization in order to avoid non-compliance, denials and/or penalties to the patient, hospital and physician(s). Initiates notifications to insurances as required. Checks for medical ...

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Showing results 21-40

All JobsPrior Authorization Representative JobsPrior Authorization Representative Jobs in Tennessee

Prior Authorization Representative information

See Tennessee salary details

$22.2K

$40.1K

$69.9K

How much do prior authorization representative jobs pay per year?

As of Aug 16, 2026, the average yearly pay for prior authorization representative in Tennessee is $40,134.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,000.00 and $39,000.00 per year, depending on experience, location, and employer.

How to become a prior authorization representative?

To become a prior authorization representative, candidates typically need a high school diploma or equivalent and should develop skills in medical terminology, insurance policies, and data entry. Relevant experience in healthcare or insurance billing can be beneficial, and some employers may require familiarity with electronic health record (EHR) systems. Certification is not mandatory but can enhance job prospects and demonstrate expertise in healthcare administration.

What are some common challenges faced by prior authorization representatives, and how can they be managed?

Prior Authorization Representatives often encounter challenges such as navigating complex insurance policies, managing high volumes of requests, and dealing with time-sensitive cases. Staying up-to-date with payer requirements and utilizing electronic health record (EHR) systems can help streamline the process. Strong communication and organizational skills are essential for collaborating with healthcare providers and insurance companies to ensure timely approvals and minimize delays for patients.

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

AspectPrior Authorization RepresentativeMedical Billing Specialist
CredentialsHigh school diploma; certification often preferredHigh school diploma; certification optional
Work EnvironmentHealthcare offices, insurance companiesMedical offices, billing companies
Primary ResponsibilitiesSecuring insurance approvals for proceduresProcessing and submitting medical claims

The Prior Authorization Representative focuses on obtaining insurance approvals before procedures, while the Medical Billing Specialist handles billing and claims processing after services are rendered. Both roles require knowledge of insurance policies and healthcare documentation, but they differ in their primary functions within the healthcare revenue cycle.

Are prior authorization jobs in high demand?

Prior authorization representative roles are in steady demand due to the increasing need for healthcare cost management and insurance verification. These jobs often require strong attention to detail and familiarity with healthcare systems and electronic health records. The demand is expected to grow as healthcare providers and insurers continue to streamline approval processes.

What does a prior authorization representative do?

A Prior Authorization Representative is responsible for reviewing and processing requests for prior authorization of medical procedures, medications, or services. They work with healthcare providers, insurance companies, and patients to ensure that the necessary documentation is submitted and meets the insurance requirements for approval. Their role helps facilitate timely access to medical care by verifying coverage and resolving any issues that may delay treatment. Excellent communication and organizational skills are important for this position.

What are the key skills and qualifications needed to thrive as a prior authorization representative, and why are they important?

To thrive as a Prior Authorization Representative, you need a strong understanding of healthcare insurance processes, medical terminology, and prior authorization guidelines, usually supported by a high school diploma or equivalent. Familiarity with healthcare management software, electronic medical records (EMRs), and payer-specific authorization portals is typically required. Attention to detail, problem-solving abilities, and effective communication are standout soft skills for this role. These competencies are essential to ensure timely and accurate processing of authorizations, minimize claim denials, and support patient access to necessary care.

What are popular job titles related to Prior Authorization Representative jobs in Tennessee?

For Prior Authorization Representative jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Prior Authorization Representative jobs in Tennessee look for?

The top searched job categories for Prior Authorization Representative jobs in Tennessee are:

Prior Authorization Representative jobs near you
Infographic showing various Prior Authorization Representative job openings in Tennessee as of August 2026, with employment types broken down into 42% Full Time, and 58% Part Time. Highlights an 100% In-person job distribution, with an average salary of $40,134 per year, or $19.3 per hour.

Reimbursement Solutions Analyst

Cardinal Health

Oak Ridge, TN

$27/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 21 days ago

Cardinal Health rating

7.8

Company rating: 7.8 out of 10

Based on 338 frontline employees who took The Breakroom Quiz

129th of 887 rated healthcare providers

Job description

Headquartered in Dublin, Ohio, Cardinal Health, Inc. (NYSE: CAH) is a global, integrated healthcare services and products company connecting patients, providers, payers, pharmacists and manufacturers for integrated care coordination and better patient management. Backed by nearly 100 years of experience, with more than 40,000 employees in nearly 60 countries, Cardinal Health ranks among the top 20 on the Fortune 500.

We currently have a career opening for a Reimbursement Solutions Analyst at Fort Sanders Regional in Oak Ridge, TN. This is an onsite position.

Shift: Monday-Friday 8:00AM-4:30PM EST

What Clinical Operations contributes to Cardinal Health

Clinical Operations is responsible for supporting the timely and quality sale, installation and monitoring of Cardinal Health products and services may also provide product and service education to facilitate technology adoption and workflow change management.

The primary purpose of this position is to oversee the evaluation and clearance procedures and treatment orders in the contracted outpatient hospital setting. The goal is to provide a detailed outline of clearance criteria as well as prior authorization and advocacy identification for procedures and medications scheduled to be given in the outpatient hospital setting. Reports to Reimbursement Solutions Supervisor, Individualized Care

Responsibilities:

  • Evaluate data input schedules from facilities to load work items
  • Collaborate with facility EHR’s to gather data to support diagnosis and medical clearances
  • Identify advocacy opportunities as it pertains to patient specific situations and insurance status
  • Apply proper clearance criteria for medication regimens as insurance indicates
  • Discuss medication options with pharmacy/physician and patient based on accessibility and availability (outpatient environment)
  • Initiate and process applications for advocacy opportunities for qualifying patients
  • Extensive contact with insurance companies to include speaking to representatives for benefit investigation as well as clinical clearance for prior authorization and medical necessity
  • Extensive patient education/counseling to determine eligibility for Advocacy.
  • Identify and resolve rejected applications, including accessing comparable drug regimen
  • Refer patients that do not qualify for programs to other outside assistance. I.e. local charities
  • Manage the drug recovery application process
  • Assign appropriate billing level to each item processed in accordance with Reimbursement Solution guidelines
  • Communicate with team lead to meet the needs of the assigned facility
  • Maintain daily accounting activities and prior authorization documentation per the Reimbursement Solution procedures.
  • Maintain security and confidentiality of patient information at all times.
  • Demonstrates extensive knowledge and understanding of relevant clinical operations, products and services
  • Influences customer decision to purchase new products and services
  • Leads the post-sales assessment, design, implementation and monitoring of new products and services in multi-site and/or complex environments
  • Develops, plans and manages customer training programs in multi-site and/or complex environments
  • Serves as lead consultant and resource to internal and external customers in multi-site and/or complex environments
  • Mentors internal staff regarding best demonstrated practices
  • Significantly influences customer acceptance and utilization of new products and services in multi-site and/or complex environments
  • Initiates discussion to obtain in-depth customer feedback for product and service improvement opportunities

Qualifications

  • 0 - 2 years of experience in related field preferred
  • High level of attention to detail and a willingness to learn
  • Strong analytical skills preferred
  • Must be self-motivated and have the ability to understand and follow instructions
  • Strong Microsoft Office skills (Excel, Word, Outlook)
  • Strong written and verbal communication
  • Able to work independently and solve problems on behalf of Cardinal and the customer
  • Must be able to prioritize work to maximize job effectiveness
  • Excellent interpersonal skills
  • Strong ability to work under pressure and meet deadlines
  • Strong telephone presence/etiquette

What is expected of you and others at this level

  • Applies basic concepts, principles, and technical capabilities to perform routine tasks
  • Works on projects of limited scope and complexity
  • Follows established procedures to resolve readily identifiable technical problems
  • Works under direct supervision and receives detailed instructions
  • Develops competence by performing structured work assignments

Pay rate: $27.00 per hour

Bonus eligible: No

Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.

  • Medical, dental and vision coverage
  • Paid time off plan
  • Health savings account (HSA)
  • 401k savings plan
  • Access to wages before pay day with myFlexPay
  • Flexible spending accounts (FSAs)
  • Short- and long-term disability coverage
  • Work-Life resources
  • Paid parental leave
  • Healthy lifestyle programs

Application window anticipated to close: 8/25/2026*if interested in opportunity, please submit application as soon as possible.

Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply.

Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law.

What Cardinal Health employees say

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About Cardinal Health

Sourced by ZipRecruiter

Cardinal Health Innovative Delivery Solutions With over 45 years of experience in helping hundreds of hospital and outpatient pharmacies, we provide access to best practice strategies and tactics to control costs, improve workflow and enhance safety. Cardinal Health Innovative Delivery Solutions is one of the largest employers of acute-care pharmacist in the United States. Cardinal Health is the employer of choice for pharmacists because we offer a variety of career opportunities in pharmacy leadership, clinical specialties, remote order entry, business management, medication therapy management and more.

Industry

Medical equipment and supplies manufacturing

Company size

10,000+ Employees

Headquarters location

Dublin, OH, US

Year founded

1971

Social media

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