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Prior Authorization Representative Jobs in Texas

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 Representative JobsPrior Authorization Representative Jobs in Texas

Prior Authorization Representative information

See Texas salary details

$22.8K

$41.2K

$71.7K

How much do prior authorization representative jobs pay per year?

As of Aug 23, 2026, the average yearly pay for prior authorization representative in Texas is $41,197.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,900.00 and $40,100.00 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 Texas?

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

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

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

Prior Authorization Representative jobs near you
Infographic showing various Prior Authorization Representative job openings in Texas as of August 2026, with employment types broken down into 45% Full Time, and 55% Part Time. Highlights an 100% In-person job distribution, with an average salary of $41,197 per year, or $19.8 per hour.

Medical Authorizations Specialist

Sparrow Company LLC

El Paso, TX • On-site

$14.50/hr

Full-time

Re-posted 7 hours ago

Job description

Sparrow Company is searching for a detail-oriented and organized Medical Authorizations Specialist to support healthcare operations by obtaining and managing insurance authorizations for patient services. This role is ideal for someone with strong knowledge of insurance processes, excellent communication skills, and the ability to work efficiently in a fast-paced healthcare environment.

RESPONSIBILITIES AND DUTIES:
  • Obtain and process prior authorizations, referrals, and pre-certifications for medical procedures, diagnostic testing, specialty services, and treatments
  • Verify patient insurance eligibility, benefits, coverage requirements, and authorization needs
  • Review clinical documentation to ensure completeness and accuracy for authorization submissions
  • Communicate with insurance companies, healthcare providers, and patients regarding authorization status and requirements
  • Track and monitor authorization requests to ensure timely approvals and prevent delays in patient care
  • Follow up on pending, denied, or incomplete authorization requests and initiate appeals when appropriate
  • Document authorization activities, approvals, denials, and communications within the electronic health record (EHR) system
  • Maintain accurate patient demographic and insurance information
  • Educate patients regarding insurance requirements, authorization processes, and financial responsibilities as appropriate
  • Collaborate with physicians, clinical staff, scheduling teams, and insurance representatives to facilitate patient care
  • Identify and resolve authorization-related issues while maintaining a high level of customer service
  • Ensure compliance with HIPAA regulations and organizational confidentiality standards
  • Maintain knowledge of payer guidelines, insurance regulations, and authorization requirements
  • Participate in training and professional development activities to remain current with healthcare industry standards and best practices
  • Consistently meet departmental productivity, quality, and turnaround time goals
  • Adhere to all organizational policies, procedures, and practices
  • Perform all other duties as assigned
REQUIREMENTS AND QUALIFICATIONS:
  • High school diploma or GED required
  • Minimum of one (1) year of experience with insurance authorizations, referrals, or prior authorizations in a healthcare setting required
  • Experience verifying insurance eligibility and benefits required
  • Experience working with electronic health records (EHR) systems preferred
  • Knowledge of medical terminology preferred
  • Strong understanding of insurance plans, payer requirements, and authorization processes
  • Excellent written, verbal, and interpersonal communication skills
  • Strong organizational skills with exceptional attention to detail
  • Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment
  • Ability to work independently and collaboratively as part of a healthcare team
  • Bilingual in English and Spanish preferred
ADDITIONAL INFORMATION:
  • Applicants may be subject to a background check.*
  • A pre-employment drug screening may be required as a condition of employment.

*A conviction does not automatically disqualify you from employment. We will consider factors such as the timing, nature, and seriousness of any offense, as well as evidence of rehabilitation.

Sparrow Company Executive Search & Staffing is an Equal Opportunity Employer.


Monday- Friday 8:00am-5:00pm

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