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Prior Authorization Jobs in Baltimore, MD (NOW HIRING)

MMBC, LLC

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Authorization Specialist

Baltimore, MD · Remote

$40K - $60K/yr

Determine whether prior authorization, pre-certification, notification, or referral is required based on the patient's payer and planned treatment. * Submit authorization requests to commercial ...

Insight Global

Remote Pharmacy Technician

Baltimore, MD · Remote

$20.50/hr

The Prior Authorization Pharmacy Technician is responsible for supporting members, providers, and pharmacies by processing prior authorization requests for prescription medications while ensuring ...

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Prior Authorization information

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How much do prior authorization jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for prior authorization in Baltimore, MD is $20.76, according to ZipRecruiter salary data. Most workers in this role earn between $17.21 and $22.93 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.
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Prior Authorization jobs near you
Infographic showing various Prior Authorization job openings in Baltimore, MD as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $43,181 per year, or $20.8 per hour.

Product Owner - Utilization Management (UM) / Prior Authorization (PA)

Baltimore, MD • On-site

Lumen Solutions Group Inc.
See more jobs at Lumen Solutions Group Inc.external

Other

Posted 19 days ago

Job description

Product Owner – Utilization Management (UM) / Prior Authorization (PA)

Lumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, and Enterprise Transformation.

Location: Baltimore, MD (Hybrid)

Job Type: Contract

We are seeking an experienced Product Owner with strong expertise in Healthcare Payer Operations, Utilization Management (UM), and Prior Authorization (PA). The ideal candidate will lead enterprise healthcare initiatives focused on optimizing end-to-end prior authorization workflows, payer integrations, and claims processing while collaborating closely with business, clinical, and technical teams. This role requires deep knowledge of GuidingCare, Facets, EDI 278 transactions, and Agile product delivery. The Product Owner will drive backlog prioritization, workflow optimization, stakeholder collaboration, and operational improvements across UM and PA programs.

Key Responsibilities

  • Lead end-to-end Prior Authorization (PA) and Utilization Management (UM) product initiatives.
  • Manage product backlog, roadmap, sprint planning, and Agile ceremonies.
  • Collaborate with Claims, IT, Clinical, Technical, and Operations teams to deliver scalable healthcare solutions.
  • Own and optimize the complete PA workflow from GuidingCare into Facets, including claims matching and authorization processing.
  • Translate business requirements into actionable user stories and product enhancements.
  • Drive workflow optimization, automation initiatives, and operational efficiency improvements.
  • Monitor KPIs including turnaround time (TAT), denials, auto-decision rates, and provider experience metrics.
  • Support healthcare integrations, EHR interoperability, and compliance initiatives.
  • Work closely with stakeholders and leadership teams to ensure successful product delivery and business alignment.

Required Qualifications

  • 15+ years of experience in Healthcare Payer Operations, Utilization Management (UM), Prior Authorization (PA), or Healthcare Delivery.
  • 8–10+ years of Product Owner/Product Management experience in healthcare environments.
  • Strong expertise in end-to-end Prior Authorization workflows and payer operations.
  • Hands-on experience with GuidingCare and Facets — MUST HAVE.
  • Strong understanding of how Prior Authorization flows into Facets and how claims matching is processed within Facets — MUST HAVE.
  • Experience working with Claims, IT, Clinical, and Technical teams.
  • Strong knowledge of EDI 278 transactions and healthcare interoperability standards.
  • Expertise in Agile/Scrum methodologies, backlog management, and roadmap planning.
  • Experience with Jira, MS Office Suite, and enterprise collaboration tools.
  • Excellent communication, stakeholder management, and problem-solving skills.
  • CSPO (Certified Scrum Product Owner) certification preferred.

Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.

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