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Prior Authorization Review Jobs (NOW HIRING)

Lincare Holdings

Authorization Specialist SSC

Nashville, TN · On-site

$17.50 - $23.25/hr

Review patient chart documentation to ensure accuracy of prior authorization submissions * Request, track, and obtain prior authorization from insurance carriers within time allotted for medical and ...

CVS Health

Prior Authorization Clinical Reviewer

Home, PA · On-site

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

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Prior Authorization Pharmacist (PBM) - Remote

Miami, FL · On-site

$53/hr

Review prior authorization requests for accuracy, appropriateness, and medical necessity * Interpret clinical criteria and plan guidelines; gather/assess clinical documentation * Communicate ...

CVS Health

Prior Authorization Clinical Reviewer

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

CVS Health

Prior Authorization Clinical Reviewer

Home, KS · On-site

$26.01 - $74.78/hr

Prior authorization review of physical and behavioral health related services. * Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ...

A-Line Staffing Solutions

Be Seen First

Prior Authorization Pharmacist (PBM) - Remote

Miami, FL · On-site

$53/hr

Review prior authorization requests for accuracy, appropriateness, and medical necessity * Interpret clinical criteria and plan guidelines; gather/assess clinical documentation * Communicate ...

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How much do prior authorization review jobs pay per hour?

As of Sep 15, 2026, the average hourly pay for prior authorization review in the United States is $20.89, according to ZipRecruiter salary data. Most workers in this role earn between $17.31 and $23.08 per hour, depending on experience, location, and employer.

What is a prior authorization review?

A Prior Authorization Review is a process used by health insurance companies to determine if a prescribed medical service, procedure, or medication will be covered under a patient's insurance plan. Before certain treatments or prescriptions are approved, the provider must submit specific documentation justifying the medical necessity. This review helps ensure that patients receive appropriate care while managing healthcare costs and preventing unnecessary procedures. The process can involve coordination between healthcare providers, insurance companies, and sometimes the patient.

What skills and qualifications are needed to thrive as a prior authorization review specialist?

To thrive as a Prior Authorization Review Specialist, you need a strong understanding of medical terminology, insurance guidelines, and healthcare regulations, typically supported by healthcare experience or related certifications. Familiarity with electronic medical record (EMR) systems, payer portals, and utilization management software is crucial. Attention to detail, effective communication, and problem-solving abilities help you navigate complex authorization processes and collaborate with providers and insurers. These skills ensure timely and accurate approvals, reducing delays in patient care and supporting organizational efficiency.

What are common challenges faced by prior authorization review specialists, and how are they addressed?

One of the main challenges in a Prior Authorization Review role is managing high volumes of requests while ensuring accuracy and compliance with payer guidelines. Specialists often need to interpret complex medical policies and coordinate with healthcare providers to gather necessary documentation, which requires strong communication and organizational skills. To address these challenges, teams typically rely on detailed training, standardized workflows, and collaboration with clinical and administrative staff. Staying current with changing insurance requirements and leveraging technology tools can also help streamline the process and reduce errors.

What are popular job titles related to Prior Authorization Review jobs?

For Prior Authorization Review jobs, the most frequently searched job titles are:

Infographic showing various Prior Authorization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 19% Part Time, 1% Temporary, and 2% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $43,459 per year, or $20.9 per hour.

Authorization Specialist SSC

Nashville, TN • On-site

Lincare Holdings
Health Care and Social Assistance • 10K+ employees
Learn more about Lincare Holdingsexternal

$17.50 - $23.25/hr

Other

Re-posted 2 days ago

Lincare rating

6.8

Company rating: 6.8 out of 10

Based on 277 frontline employees who took The Breakroom Quiz

Job description

Insurance Verification Specialist

This employee verifies insurance, obtaining authorizations and documents needed to confirm order; responsible for communicating directly with the patient, doctors' offices, insurance companies, and centers associated with the patient's account.

Job Responsibilities:
  • Prioritize incoming prior authorization requests
  • Evaluate and triage prior authorization rejections to determine validity of the prior authorization
  • Communicate as needed with patients regarding clinical information to be used when submitting the prior authorization
  • Review patient chart documentation to ensure accuracy of prior authorization submissions
  • Request, track, and obtain prior authorization from insurance carriers within time allotted for medical and services using my meds, fax, or verbal communication
  • In a timely manner, follow up on prior authorizations that have been submitted with no response from the insurance carrier
  • When justifiable, initiate appeals for denied authorizations
  • Maintain patient files on Prior Authorizations tracker
  • Compose letters for various situations to include medical necessity letters and appeal letters
  • Use ICD-10 diagnosis codes accurately and properly in the submission of prior authorizations
  • Contact patients via the platform to update the status of their prior authorization
  • Assist patients with medication assistance programs to include obtaining signatures from providers, submit documentation to medical assistance programs, and tracking progress
  • Demonstrate and apply knowledge of medical terminology high proficiency of general medical office procedures including HIPAA regulations
  • Communicate with pharmacies/insurance carriers via phone, fax, or written communication
  • Maintain a level of productivity suitable for the department
  • Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
  • Evaluate options and make efficient decisions
  • Maintain consistently accurate records
  • Proficiency with multiple programs that include the use of internet and email
  • Learn how to use new software AS400 LITE

Education and Experience:

  • High School Diploma or equivalent (GED) required

Physical Demands:

The employee may frequently lift and/or move up to 10 pounds and may occasionally lift and/or move up to 25 pounds.

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About Lincare

Sourced by ZipRecruiter

Lincare's mission is to set the standard for excellence, transforming the way respiratory care is delivered in the home. We are inspired by a vision to enable patients with chronic conditions to remain engaged in life, with the peace of mind that we are caring for them. Lincare is a dynamic, growing company with over 1,000 locations in 49 states, employing over 13,000 people who share our corporate vision for quality care and service.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Clearwater, FL, US

Year founded

1987

Social media

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