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How much do prior authorization rn jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for prior authorization rn in Pennsylvania is $42.35, according to ZipRecruiter salary data. Most workers in this role earn between $31.59 and $50.10 per hour, depending on experience, location, and employer.

What is a Prior Authorization RN?

A Prior Authorization RN is a registered nurse who specializes in reviewing and processing prior authorization requests for medical procedures, medications, or treatments. They evaluate clinical documentation to determine if requests meet insurance or regulatory criteria and often serve as a liaison between healthcare providers, patients, and insurance companies. Their role helps ensure that care is medically necessary and covered by the patient's health plan, streamlining access to important healthcare services while controlling costs.

What does a Prior Authorization RN do?

A prior authorization RN is a registered nurse who assesses applications for specific treatments, medical procedures, and medications. In this job, you review each request for medical coverage and determine the necessity or potential benefits of the treatment or medicine. You assess patient information and other factors to decide whether or not to authorize coverage. Your duties as a prior authorization RN also include reviewing denials of benefits and seeking additional information that could alter the initial decision. You document your findings for each case and present the evidence along with your decision. It is your job to review the case for each patient thoroughly while following all government regulations and healthcare provider policies.

What are the key skills and qualifications needed to thrive as a Prior Authorization RN, and why are they important?

To thrive as a Prior Authorization RN, you need a current RN license, strong clinical assessment skills, and a solid understanding of insurance guidelines and medical necessity criteria. Familiarity with utilization management software, electronic health records (EHRs), and payer-specific authorization systems is essential. Exceptional attention to detail, critical thinking, and effective communication help you advocate for patients and collaborate with healthcare providers and insurers. These skills ensure the efficient processing of authorizations, reduce delays in care, and support patients in receiving appropriate treatments.

What are some common challenges faced by Prior Authorization RNs, and how can they be addressed?

Prior Authorization RNs often navigate complex insurance guidelines and manage high volumes of requests, which can be challenging due to frequent policy updates and tight timelines. Staying organized, maintaining up-to-date knowledge of payer requirements, and leveraging electronic health record (EHR) systems can help streamline the process. Collaboration with providers and insurance representatives, as well as ongoing training, are essential for efficiently resolving issues and ensuring timely patient care.

What is the difference between Prior Authorization Rn vs Medical Coder?

AspectPrior Authorization RnMedical Coder
CredentialsRN license, possibly certifications in case management or utilization reviewCertification in coding (CPC, CCS), no RN license required
Work EnvironmentHospitals, insurance companies, healthcare facilitiesMedical offices, hospitals, insurance companies
Primary ResponsibilitiesReviewing and obtaining prior authorizations for treatments and proceduresTranslating medical records into coded data for billing and documentation

While both roles are integral to healthcare administration, the Prior Authorization RN focuses on obtaining approvals for patient care, requiring nursing credentials and clinical knowledge. In contrast, Medical Coders specialize in coding medical records for billing, emphasizing coding certifications. Understanding these differences helps healthcare professionals and job seekers identify the right career path or job opportunity.

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Prior Authorization Rn jobs near you
Infographic showing various Prior Authorization Rn job openings in Pennsylvania as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 20% Part Time, 1% Temporary, and 3% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $88,079 per year, or $42.3 per hour.

Practice Prior Authorization Specialist, ENT and Allergy

St. Luke's Hospital

Freemansburg, PA • On-site

$17.75 - $23.75/hr

Other

Medical, Vision, Life

Posted 4 days ago

Job description

Practice Prior Authorization And Referral Specialist

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The Practice Prior Authorization and Referral Specialist is responsible for the coordination of prior-authorizations and referral process for patients being referred for specialty care, medications, and diagnostic procedures. Performs insurance verification, obtaining pre-authorizations, scheduling, and referrals. The specialist will secure the necessary prior authorization, then notify the patient aiding in the coordination of patient care.

Job Duties And Responsibilities:

  • Receive request for patient requiring specialty care through the electronic health record (EHR), direct order by provider communication, phone, and/or fax.
  • Ensure patient demographic as well as insurance information are most accurate.
  • Reviews patient insurance information and eligibility / verification to obtain prior authorization for specialty care and/or services.
  • Obtain prior authorization from insurance companies prior to services being ordered and/or rendered.
  • Documents in EHR prior authorization approval to ensure proper reimbursement.
  • Works in collaboration with other supporting services / entities, central scheduling, and pre-encounters department.
  • Responds to written as well as telephone inquires from patients, insurances, pharmacies, other outpatient/inpatient departments, and facilities regarding planned specialty care and/or services.
  • Review and follow up on authorization and/or claim denials.
  • Notify ordering provider of a prior authorization denials and if peer to peer need to be scheduled.
  • Other duties as assigned.

Physical And Sensory Requirements:

Sitting for up to 8 hours per day, 3 hours at a time. Consistent use of hands and fingers for typing, telephone, data entry, etc. Occasional twisting and turning. Uses upper extremities to life and carry up to 15 pounds. Stoops, bends, and reaches above shoulder level to retrieve needed materials. Hearing as it relates to normal conversation. Seeing as it relates to general vision.

Education:

High school diploma or equivalent required. Prior authorization experience preferred.

Training And Experience:

One to two years of experience in medical billing, a medical office or insurances preferred. Working knowledge of medical office procedures as well as detailed understanding of ICD 10 and CPT codes. Knowledge of regulatory standards and compliance requirements.

Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!

St. Luke's University Health Network is an Equal Opportunity Employer.

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