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How much do prior authorization jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for prior authorization in Delaware is $20.91, 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 prior authorization?

Prior authorization is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication. Before the provider delivers the service, they must receive approval from the insurer. This process helps control costs and ensures that the service or medication is medically necessary. It often involves submitting documentation and waiting for a decision, which can sometimes delay patient care. Patients and providers should check with insurance companies to understand which services require prior authorization.

What are the key skills and qualifications needed to thrive as a prior authorization specialist, and why are they important?

To thrive as a Prior Authorization Specialist, you need strong knowledge of medical terminology, insurance processes, and healthcare regulations, typically supported by a high school diploma or associate degree in a healthcare-related field. Familiarity with electronic medical records (EMR) systems, insurance portals, and authorization management software is essential. Attention to detail, effective communication, and problem-solving abilities help you navigate complex cases and collaborate with providers and payers. These skills ensure accurate and timely processing of authorizations, minimizing delays in patient care and reducing administrative errors.

What are some common challenges faced by prior authorization specialists, and how can applicants prepare for them?

Prior Authorization specialists often encounter challenges such as navigating complex insurance policies, managing high volumes of requests, and communicating effectively with both healthcare providers and insurance representatives. To prepare for these challenges, applicants should develop strong organizational skills, attention to detail, and a good understanding of medical terminology and insurance guidelines. Familiarity with electronic health records (EHR) systems and the ability to multitask in a fast-paced environment are also valuable assets in this role.

What is the difference between Prior Authorization vs Medical Billing Specialist?

AspectPrior AuthorizationMedical Billing Specialist
CredentialsTypically requires knowledge of insurance policies, healthcare regulations, and sometimes certifications like NCQA or AHIPRequires knowledge of coding, billing procedures, and often certifications like CPC or CCS
Work EnvironmentHealthcare provider offices, insurance companies, or hospitalsMedical offices, billing companies, or healthcare facilities
Employer & Industry UsageUsed by healthcare providers and insurers to approve treatments or proceduresUsed by healthcare providers and billing companies to process claims and payments

While both roles are essential in healthcare administration, Prior Authorization focuses on obtaining approval for treatments, whereas Medical Billing Specialists handle the financial aspects of claims processing. Understanding their differences helps clarify their distinct responsibilities within the healthcare system.

How do I become a prior authorization specialist?

To become a prior authorization specialist, you typically need a high school diploma or equivalent, along with knowledge of medical billing and coding. Relevant skills include attention to detail, communication, and familiarity with insurance policies and electronic health record systems. Certification in medical billing or coding can enhance job prospects.

What career paths follow prior authorization?

Careers following prior authorization include roles such as medical billers, claims processors, healthcare administrators, and utilization review specialists. These positions often require knowledge of insurance policies, medical coding, and healthcare regulations, and may involve certifications like CPC or CCS. Advancement can lead to supervisory or managerial roles within healthcare administration or insurance companies.

What is a prior authorization job?

A prior authorization job involves reviewing and processing requests from healthcare providers to approve specific medical treatments, medications, or procedures before they are administered. The role requires knowledge of insurance policies, medical terminology, and attention to detail, often utilizing electronic health record systems. It is essential for ensuring that treatments meet insurance criteria and are covered under the patient's plan.
More about Prior Authorization jobs

What are the most commonly searched types of Prior Authorization jobs in Delaware?

The most popular types of Prior Authorization jobs in Delaware are:

What are popular job titles related to Prior Authorization jobs in Delaware?

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

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

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

What cities in Delaware are hiring for Prior Authorization jobs?

Cities in Delaware with the most Prior Authorization job openings:

Prior Authorization jobs near you
Infographic showing various Prior Authorization job openings in Delaware as of August 2026, with employment types broken down into 100% Full Time. Highlights an 75% In-person, and 25% Remote job distribution, with an average salary of $43,497 per year, or $20.9 per hour.

UM Authorization Analyst 2 Bilingual

Starling Oncology

Delaware City, DE • Remote

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Starling Oncology (NASDAQ: STLN) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With more than 400 employed and network clinicians and over 100 clinics and network locations of care across five states and growing, Starling Oncology is changing oncology for the better. For more information, visit www.starlingoncology.com.

Join a team where your clinical insight directly shapes patient outcomes and care quality. As a UM Authorization Analyst II, you'll play a critical role in ensuring timely, evidence-based decisions that support both patients and providers—while working in a collaborative environment that values accuracy, efficiency, and professional growth.

JOB PURPOSE AND SUMMARY:

The UM Authorization Analyst II is responsible for ensuring the timely and accurate processing of medical procedure authorizations. This role includes reviewing authorization requests, maintaining compliance with regulations, and coordinating with healthcare providers and insurance companies to support patient care.

This role can be worked remotely from anywhere in the contiguous United States, and will be working on an Eastern time schedule.

ESSENTIAL DUTIES AND RESPONSBILITIES:

  • Leading daily huddles with UM Physician Reviewers to address risks related to timely decision-making and documentation accuracy.
  • Creating, reviewing, and administering corrective action forms with support and guidance from the Director, Utilization Management Compliance.
  • Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance.
  • Working closely with the Director, Utilization Management Compliance to identify deficiencies and areas for improvement.
  • Partnering with delegated entities to ensure the accuracy and compliance of provider credentialing processes, conducting thorough sanction and exclusion checks, and promoting the effective utilization of QuickCap workflows within Utilization Management operations.
  • Reporting and Analysis: prepare and present regular reports on authorization activities, including volume, turnaround times, and issues.
  • Identifying and forwarding standard or expedited appeals to the appropriate health plan.
  • Staying current on industry regulations, guidelines, and best practices related to utilization management and review.
  • Participating in monitoring and analyzing Inter-Rater Reliability (IRR) testing, identifying trends, and recommending best practice improvements to consistent decision-making.
  • Demonstrating expertise in health plan delegation requirements, including Preparation and submission of reports, participate in implementation of corrective action plans (CAPs), updates to policies and procedures, and monitoring and applying regulatory changes to maintain contractual compliance.
  • Ensuring adherence to key performance indicators (KPIs) and service level agreements (SLAs) for all delegated Utilization Management (UM) functions.
  • Performing other duties as assigned to support operational goals.
  • Living and exemplify Starling Oncology core values, providing outstanding customer service and promoting a positive experience for patients and staff members.

KNOWLEDGE, SKILLS, AND ABILITIES:

  • Excellent communication and interpersonal skills.
  • In-depth knowledge of medical procedure authorization processes and healthcare insurance requirements.
  • Ability to analyze data and implement process improvements.
  • Proficiency with medical billing software and electronic health records (EHR) systems.
  • Strong organizational skills and attention to detail.
  • Strong understanding of evidence-based guidelines (MCG, National Coverage Determinations, Local Coverage Determinations).
  • Understanding of prior authorization regulatory requirements and turnaround time expectations (CMS, AHCA, NCQA, URAC).

REQUIRED EXPERIENCE, EDUCATION AND/OR TRAINING:

  • Associate's degree in health information management, or a healthcare related field. Bachelor's preferred.
  • 4-6 years of experience in utilization management.
  • Bilingual in English and Spanish required.

PHYSICAL WORKING REQUIREMENTS:

The position involves prolonged periods of sitting at a desk, extensive computer use, and phone interaction. Additionally, the role may require occasional lifting of up to 20 pounds for office supplies or equipment.

The physical demands described above are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. 

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$71,000—$85,000 USD

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