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Prior Authorization Jobs in Lexington, SC (NOW HIRING)

Healthcare Support Staffing

Clinical Pharmacist

Columbia, SC · On-site

$109K - $130K/yr

Prior Authorizations Monitor and review prior authorization requests for medications Develop and design clinical edits to adjudicate claims and enhance drug utilization Analyze pharmacy cost of care ...

Summit BHC

Intake Clinician PRN

Peak, SC · On-site

$33K - $38K/yr

Facilitates intake, admission, and prior authorization process for incoming patients. * Performs insurance benefit verifications, disseminating the information gathered to patients, their families ...

PruittHealth

Pharmacy Technician- Order Entry

Lexington, SC · On-site

$14.50 - $17.25/hr

Assists with processing of prior authorizations and third party payor medication rejections. ESSENTIAL JOB FUNCTIONS, DUTIES, AND RESPONSIBILITIES: * Enters orders accurately into patient medication ...

PruittHealth

Pharmacy Technician- Order Entry

Lexington, SC · On-site

$14.50 - $17.25/hr

Assists with processing of prior authorizations and third party payor medication rejections. ESSENTIAL JOB FUNCTIONS, DUTIES, AND RESPONSIBILITIES: * Enters orders accurately into patient medication ...

PruittHealth

Pharmacy Technician- Order Entry

Lexington, SC

$14.50 - $17.25/hr

Assists with processing of prior authorizations and third party payor medication rejections. ESSENTIAL JOB FUNCTIONS, DUTIES, AND RESPONSIBILITIES: * Enters orders accurately into patient medication ...

Tapestry Wellness Institute LLC

Be Seen First

Medical Reimbursement Specialist

Columbia, SC · On-site

... and prior authorization requirements. · Monitor unpaid, denied, rejected, or underpaid claims and initiate timely corrective action to support reimbursement. · Communicate professionally with ...

Infojini Inc

Senior Business Analyst

Columbia, SC · On-site

$85K - $110K/yr

Member Provider Claims Prior Authorization Finance These work streams will support the following modules for RMMIS: Business Intelligence System Administrative Services Organization (ASO) for Fee for ...

Columbia Eye Clinic

FINANCIAL COUNSELOR

Lexington, SC · On-site

$16.25 - $21.25/hr

This position is responsible for obtaining prior authorizations and estimating patient responsibility for all surgeries and procedures by successfully completing the authorization process with payers.

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Prior Authorization information

See Lexington, SC salary details

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How much do prior authorization jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for prior authorization in Lexington, SC is $17.88, according to ZipRecruiter salary data. Most workers in this role earn between $14.81 and $19.76 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 Lexington, SC?

The most popular types of Prior Authorization jobs in Lexington, SC are:

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

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The top searched job categories for Prior Authorization jobs in Lexington, SC are:

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Cities near Lexington, SC with the most Prior Authorization job openings:

Prior Authorization jobs near you
Infographic showing various Prior Authorization job openings in Lexington, SC as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 19% Part Time, 1% Temporary, and 3% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $37,199 per year, or $17.9 per hour.

Prior Authorization Specialist / Insurance Verification Coordinator

Prosperity Placement Solutions

Columbia, SC • On-site

$23 - $26/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 days ago

Job description

Prior Authorization Specialist / Insurance Verification Coordinator

Job Details

  • Pay: $23.00 - $26.00 an hour
  • Job Type: Full-time
  • Schedule: Monday to Friday, 8:00 AM – 5:00 PM (No weekends)
  • Benefits: Medical, Dental, Vision, 401(k), PTO, Tuition Assistance (Full Benefits Package)

About Us

We provide comprehensive ambulatory and home-based infusion services to both acute and chronically ill patients. Our centers care for people by providing patients and their families with a convenient, affordable, and safe place to receive infusion treatments.

We believe in creating a healthcare experience that goes beyond just a job. We are a connected group of caretakers who work together to restore health and hope to our patients. For our employees, this means a culture of belonging, mutual respect, empathy, and continuous collaboration.

Role Overview (As a Patient Access Navigator)

We are seeking an Insurance Case Manager / Prior Authorization Specialist to function as a vital bridge between our clinical team, intake coordinators, and insurance payers. In this role, you aren't just processing paperwork—you are a Patient Access Navigator, ensuring patients get timely access to life-changing infusion therapies by accurately verifying health benefits and securing critical authorizations.

What You'll Do (Essential Functions)

  • Verify Benefits: Utilize web portals and phone outreach to verify comprehensive insurance benefits.
  • Secure Authorizations: Review payer medical policies to determine medical necessity based on guidelines and FDA indications; manage the prior authorization and reauthorization process.
  • Ensure Data Integrity: Obtain and review patient data, signed written orders (SWO), and letters of medical necessity (LMN) from referring physician offices.
  • Collaborate: Partner closely with Intake Coordinators, Nurse Managers, and the Reimbursement team to ensure smooth patient onboarding and high operational standards.
  • Communicate & Document: Complete insurance verification forms, scan documents into electronic medical records, and provide clear coverage summaries to the team.
  • Financial Coordination: Coordinate first payments and payment plans for patients when necessary.
  • Support: Participate in an on-call rotation for after-hours and holidays as needed.

Qualifications & Skills

  • Education: High School Diploma or Equivalent (Required).
  • Experience: 1+ years of experience managing health insurance benefit verifications and prior authorizations (Required). Specialty medication or infusion experience is a plus.
  • Software: Proficiency in MS Office (Outlook, Word, Excel) and electronic medical records.
  • Attributes: Ability to stay calm, organized, and focused in an ambiguous, fast-paced environment. Strong teamwork and relationship-building skills.

Full Benefits Package

  • Comprehensive Medical, Dental, and Vision Insurance
  • Company-Paid Life Insurance + Voluntary Life & Disability
  • Flexible Spending Accounts (FSA) & Health Savings Account (HSA)
  • 401(k) Retirement Plan
  • Paid Time Off (PTO) + 8 Paid Company Holidays
  • Tuition Assistance & Employee Referral Program
  • Employee Assistance Program (EAP) & Employee Discounts
  • Ramsey SmartDollar Financial Wellness Program

Physical Demands

  • Prolonged periods of sitting, reading, and keyboarding/computer vision.
  • Frequent standing, walking, bending, twisting, talking, and hearing.
  • Occasionally lifting and/or moving up to 25 pounds.

Our Commitment to Patient Advocacy

At our core, we believe that patient advocacy is at the heart of everything we do, regardless of our roles within the organization. Each member of our team is dedicated to putting the needs and well-being of our patients first. Whether we're working directly with patients or supporting them behind the scenes, our commitment to being a compassionate advocate is paramount.

We understand that every interaction, every decision, and every effort contributes to the quality of care our patients receive. Together, we strive to ensure that every individual feels heard, supported, and empowered throughout their healthcare journey. This dedication to patient-centered care is what creates our standard of excellence that defines us and enriches the lives of those we serve.

Apply Today

Take the next step in your healthcare career and join a team dedicated to delivering exceptional infusion care!

To apply or for immediate consideration, please contact Brian Harris Email: Brian@prosperityplacement.com Phone: 941-999-4291