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Prior Authorization Representative Jobs (NOW HIRING)

TTI

Customer Service Rep II - Non-Exempt

Atlanta, GA

$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 ...

MDxHealth

Prior Authorization Specialist

Irvine, CA · On-site

$19.26 - $23/hr

Interacts with clients, insurance companies, patients, and sales representatives, as necessary, to request for prior authorizations. Responsible for documenting account activity, updating patient and ...

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 ...

Medix

Prior Authorization Specialist

Phoenix, AZ · On-site

$18 - $21/hr

The actual posting represents a position at one of our clients. Job Summary Our client is seeking a dedicated Prior Authorization Specialist responsible for communicating with insurance providers to ...

US Tech Solutions

$17 - $19/hr

Prior Authorization Specialist takes in-bound calls from providers, pharmacies, members, etc ... The Rep I, Clinical Services will also assist with other duties as needed to include but not ...

Medix

Prior Authorization Specalist

Pittsburgh, PA · On-site

$22/hr

The actual posting represents a position at one of our clients. Job Summary Our client is seeking a Prior Authorization responsible for liaising with prescriber offices, utilizing technology for ...

Varite

$16.75 - $22.25/hr

The Rep I, Clinical Services takes in-bound calls from providers, pharmacies, members, etc ... Work closely with providers to process prior authorization (PA) and drug benefit exception requests ...

Cinq Group

Prior Authorization Specialist

Altamonte Springs, FL · On-site

$16.75 - $22.50/hr

Coordinates appointment of representative document with patient and physician office. * Completes status check with insurance company regarding receipt of prior authorization and appeal and approval ...

Mission Hospital

Authorization Representative

Largo, FL · On-site

$14.50 - $19.75/hr

Prior Authorization Specialist and Authorization Representative preferred Benefits HCA Florida Heart Institute, offers a total rewards package that supports the health, life, career and retirement of ...

Cinq Group

Prior Authorization Specialist

Altamonte Springs, FL · On-site

$16.75 - $22.50/hr

Coordinates appointment of representative document with patient and physician office. * Completes status check with insurance company regarding receipt of prior authorization and appeal and approval ...

Mission Hospital

Authorization Representative

Largo, FL · On-site

$14.50 - $19.75/hr

Prior Authorization Specialist and Authorization Representative preferred Benefits HCA Florida Heart Institute, offers a total rewards package that supports the health, life, career and retirement of ...

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Prior Authorization Representative information

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$24.5K

$44.2K

$77K

How much do prior authorization representative jobs pay per year?

As of Jun 6, 2026, the average yearly pay for prior authorization representative 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 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.

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.
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Prior Authorization Representative jobs near you
Customer Service Rep II - Non-Exempt

Customer Service Rep II - Non-Exempt

TTI

Atlanta, GA

$15.50 - $21/hr

Other

Posted 25 days ago

Job description

Prior Authorization Representative

The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. Works directly with physician offices and payers to facilitate patient access to various therapies. Representative will ensure patient insurance coverage and benefits, identify requirements for prior approval and submit for authorization. Assists with appealing prior authorization denials, retro authorization or other special cases

Responsibilities Include, But Are Not Limited To
  • Validates insurance patient's coverage, communicate any issues with benefits or coverage to the appropriate managers
  • Checks the requirements for prior authorization and initiates as required
  • Coordinates required paperwork, clinical notes and forms for submission to support request and initiates as required
  • Follows up frequently to ensure visibility on authorization status throughout the approval process
  • Basic knowledge payer payment process with detailed knowledge on the payer prior authorization process
  • Basic ICD9/10 and CPT code familiarity, expert knowledge on subset of Medtronic therapy codes
  • Superior customer service skills with outstanding communication skills to use with various stakeholders; physicians, sales representatives, payer representatives, utilization reviewers, various internal and external stakeholders,
  • Advanced Microsoft Excel skills.

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