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Prior Authorization Representative Jobs in Tennessee

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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 Sep 5, 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.

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 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 representative jobs in high demand?

Prior Authorization Representative jobs are in steady demand due to the growing need for healthcare administrative support and insurance processing. These roles often require strong communication skills and familiarity with medical billing and coding systems, making them a stable career option in the healthcare industry.

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 1% As Needed, 78% Full Time, 17% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $40,134 per year, or $19.3 per hour.

Field Reimbursement Manager (FRM) - South East

Otsuka

Nashville, TN

$134K - $201K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

Key responsibilities

  • Educate healthcare providers and their staff on access, coverage, reimbursement processes, claims submissions, and coding requirements

  • Analyze payer criteria and provide product access expertise to healthcare offices

  • Manage daily field-based activities by interacting with key stakeholders across various care sites

Job description

Position Summary

The Field Reimbursement Manager (FRM) serves as the subject-matter expert on reimbursement, access, and coverage issues for our products, primarily focusing on Nephrology and Rare Disease. This role operates as a crucial liaison between healthcare providers (HCPs), internal teams, and external stakeholders to facilitate appropriate patient access to our products.

Key Responsibilities:

  • Educate HCPs and their staff on matters related to access, coverage, reimbursement processes, claims submissions, and coding requirements

  • Analyze payer criteria and provide product access expertise to healthcare offices

  • Coordinate with Hubs on individual patient cases, including patient support services and enrollment

  • Collaborate with Field Sales, Specialty Pharmacy Accounts, and other matrix partners

  • Manage daily field-based activities, spending 60-70% of time interacting with key stakeholders across various care sites

  • Execute collaborative territory plans through partnerships with internal and external stakeholders

  • Review and educate offices on payer policies, including prior authorization requirements

  • Provide feedback to internal teams on local payer trends and access issues

  • Assist in resolving patient-specific coverage challenges when requested by healthcare providers

Skills and Abilities:

  • Excellent verbal and written communication skills

  • Strong interpersonal and consultative abilities

  • Self-directed with outstanding organizational skills

  • Ability to build and maintain strong relationships with internal and external customers

  • Proficient in delivering training and presentations

Qualifications

Required:

  • Bachelor's degree

  • 5+ years of pharmaceutical industry experience, with focus on payer policy and reimbursement

  • 3+ years of experience in benefit verifications, prior-authorization requirements, or equivalent experience in patient access, billing, and coding in rare disease

Preferred:

  • Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially Medicare Part D

  • Experience in "Buy and Bill" reimbursement environment

  • Nephrology experience strongly preferred

  • Comprehensive understanding of US healthcare system payer billing practices

  • Proficiency in MS Office suite

Travel:

  • Ability to travel up to 60-70% domestically

  • Valid driver's license required

Competencies
Accountability for Results - Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change.
Strategic Thinking & Problem Solving - Make decisions considering the long-term impact to customers, patients, employees, and the business.
Patient & Customer Centricity - Maintain an ongoing focus on the needs of our customers and/or key stakeholders.
Impactful Communication -Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka.
Respectful Collaboration - Seek and value others' perspectives and strive for diverse partnerships to enhance work toward common goals.
Empowered Development - Play an active role in professional development as a business imperative.

Minimum $134,615.00 - Maximum $201,250.00, plus incentive opportunity: The range shown represents a typical pay range or starting pay for individuals who are hired in the role to perform in the United States. Other elements may be used to determine actual pay such as the candidate's job experience, specific skills, and comparison to internal incumbents currently in role. Typically, actual pay will be positioned within the established range, rather than at its minimum or maximum. This information is provided to applicants in accordance with states and local laws.

Application Deadline: This will be posted for a minimum of 5 business days.

Company benefits: Comprehensive medical, dental, vision, prescription drug coverage, company provided basic life, accidental death & dismemberment, short-term and long-term disability insurance, tuition reimbursement, student loan assistance, a generous 401(k) match, flexible time off, paid holidays, and paid leave programs as well as other company provided benefits.

Come discover more about Otsuka and our benefit offerings;https://ah-prod.com/multi/videoplayer/player.html?v=6385356920112.


Join Our Talent Community: Stay connected with Otsuka by joining our Talent Community. Tell us about your interests, and we'll notify you about future opportunities that align with your background. https://community.hireez.com/cielo-otsuka/82cb3591

Disclaimer:

This job description is intended to describe the general nature and level of the work being performed by the people assigned to this position. It is not intended to include every job duty and responsibility specific to the position. Otsuka reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.

Otsuka is an equal opportunity employer. All qualified applicants are encouraged to apply and will be given consideration for employment without regard to race, color, sex, gender identity or gender expression, sexual orientation, age, disability, religion, national origin, veteran status, marital status, or any other legally protected characteristic.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation, if you are unable or limited in your ability to apply to this job opening as a result of your disability. You can request reasonable accommodations by contacting EEAccommodations@otsuka-us.com.

Statement Regarding Job Recruiting Fraud Scams

At Otsuka we take security and protection of your personal information very seriously. Please be aware individuals may approach you and falsely present themselves as our employees or representatives. They may use this false pretense to try to gain access to your personal information or acquire money from you by offering fictitious employment opportunities purportedly on our behalf.

Please understand, Otsuka will never ask for financial information of any kind or for payment of money during the job application process. We do not require any financial, credit card or bank account information and/or any payment of any kind to be considered for employment. We will also not offer you money to buy equipment, software, or for any other purpose during the job application process. If you are being asked to pay or offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to exercise caution when you receive such an offer of employment.

Otsuka will also never ask you to download a third-party application in order to communicate about a legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo, Gmail, Hotmail, etc, and not from an official Otsuka email address. Please take extra caution while examining such an email address, as the scammers may misspell an official Otsuka email address and use a slightly modified version duplicating letters.

To ensure that you are communicating about a legitimate job opportunity at Otsuka, please only deal directly with Otsuka through its official Otsuka Career website https://vhr-otsuka.wd1.myworkdayjobs.com/en-US/External.

Otsuka will not be held liable or responsible for any claims, losses, damages or expenses resulting from job recruiting scams. If you suspect a position is fraudulent, please contact Otsuka's call center at: 800-363-5670. If you believe you are the victim of fraud resulting from a job recruiting scam, please contact the FBI through the Internet Crime Complaint Center at: https://www.ic3.gov, or your local authorities.

Otsuka America Pharmaceutical Inc., Otsuka Pharmaceutical Development & Commercialization, Inc., and Otsuka Precision Health, Inc. ("Otsuka") does not accept unsolicited assistance from search firms for employment opportunities. All CVs/resumes submitted by search firms to any Otsuka employee directly or through Otsuka's application portal without a valid written search agreement in place for the position will be considered Otsuka's sole property. No fee will be paid if a candidate is hired by Otsuka as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails.

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