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Prior Authorization Jobs in Raleigh, NC (NOW HIRING)

Actalent

Pharmacy Technician

Cary, NC

$20 - $25/hr

Prior experience in obtaining prior authorizations Additional Skills & Qualifications * Certified Pharmacy Technician (CPhT) preferred * Experience in retail pharmacy * Familiarity with Microsoft ...

Actalent

Pharmacy Technician

Cary, NC

$20 - $25/hr

Prior experience in obtaining prior authorizations Additional Skills & Qualifications * Certified Pharmacy Technician (CPhT) preferred * Experience in retail pharmacy * Familiarity with Microsoft ...

Actalent

Pharmacy Technician

Cary, NC

$20 - $25/hr

Prior experience in obtaining prior authorizations Additional Skills & Qualifications * Certified Pharmacy Technician (CPhT) preferred * Experience in retail pharmacy * Familiarity with Microsoft ...

Samprasoft

SWET-Software Engineer in Test 4

Durham, NC · On-site

Build Medical / Care Management platform, providing market-leading solution for Utilization Mgmt., Prior Authorization, Case & Disease Management and Concurrent Review. Top Requirements: * Cypress

Pharmacy Careers

MTM Pharmacist

Raleigh, NC · On-site +1

$52 - $62.50/hr

Competitive pay, benefits, and opportunities to expand into roles like prior authorization, clinical review, or population health. About Us We partner with health plans, PBMs, and healthcare ...

Actalent

Pharmacy Technician

Cary, NC

$17.25 - $21/hr

Support prior authorization processes and related communications as needed to help patients obtain their medications. * Provide professional, courteous customer service in every interaction ...

UNC HEALTH

Transplant Financial Coordinator

Chapel Hill, NC · On-site

$20.74 - $29.52/hr

Contacts commercial insurance company to verify benefits and obtains prior authorization/pre-certification for the transplant admission. Contacts government insurance agencies to obtain specific ...

UNC HEALTH

Outpatient Pharmacy Tech II

Smithfield, NC · On-site

$18.12 - $25.51/hr

Returns unpurchased medications to stock and processes credits. 6. Solves issues with patient payment (prior authorization, patient assistance needed, etc.). Sells prescriptions to patients and ...

Akumin

Patient Coordinator - PRN

Raleigh, NC · On-site

$17 - $22.25/hr

May be responsible for verifying insurance coverage and obtain prior authorization. Patient Assistance: * May perform preliminary screening of patients prior to procedures, which may include medical ...

Akumincorp

Patient Coordinator - PRN

Raleigh, NC

$17 - $22.25/hr

May be responsible for verifying insurance coverage and obtain prior authorization. Patient Assistance: * May perform preliminary screening of patients prior to procedures, which may include medical ...

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All JobsPrior Authorization JobsPrior Authorization Jobs in Raleigh, NC

Prior Authorization information

See Raleigh, NC salary details

$13

$20

$31

How much do prior authorization jobs pay per hour?

As of Jun 29, 2026, the average hourly pay for prior authorization in Raleigh, NC is $20.31, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $22.45 per hour, depending on experience, location, and employer.

How much do precertification specialists make?

Precertification specialists typically earn a median annual salary between $40,000 and $55,000, depending on experience, location, and employer. They often require knowledge of insurance policies and medical billing software, with some roles offering additional certifications to increase earning potential.

What Is Prior Authorization?

Prior authorization is a check done by insurance companies and other third-party payers to determine whether or not they should pay for a medical procedure or specific medication. Factors that can trigger prior authorization requests include things like age, the availability of alternative medicines, or the need to check for drug interactions. If they reject the prior authorization, payers often require doctors to attempt the insurance company's preferred procedure and verify unsuccessful results before accepting an alternative treatment plan. Pre-authorization requests can take up to 30 days, though insurance companies and healthcare providers are continuing to work on ways to cut this time down.

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.

What does a prior authorization job do?

A prior authorization specialist reviews and processes requests for approval of medical procedures, medications, or treatments from insurance companies. They verify patient information, ensure documentation is complete, and communicate with healthcare providers and insurers to obtain necessary approvals, often using electronic health record systems. This role helps ensure that necessary care is authorized while complying with insurance policies.

What job makes $10,000 a month without a degree?

High-paying jobs that can reach $10,000 a month without a degree include roles like sales managers, real estate brokers, or certain skilled trades such as electricians or plumbers, especially with experience and certifications. These positions often require strong skills, industry knowledge, and sometimes licensing, but not necessarily a college degree.

What is prior authorization in healthcare?

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 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 working in insurance companies, healthcare providers, or pharmacy benefit management companies.
More about Prior Authorization jobs
What are the most commonly searched types of Prior Authorization jobs in Raleigh, NC? The most popular types of Prior Authorization jobs in Raleigh, NC are:
What are popular job titles related to Prior Authorization jobs in Raleigh, NC? For Prior Authorization jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Prior Authorization jobs in Raleigh, NC look for? The top searched job categories for Prior Authorization jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Prior Authorization jobs? Cities near Raleigh, NC with the most Prior Authorization job openings:
Prior Authorization jobs near you
Infographic showing various Prior Authorization job openings in Raleigh, NC as of June 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $42,244 per year, or $20.3 per hour.
Authorization & Health Information Specialist

Authorization & Health Information Specialist

North Carolina Specialty Hospital

Durham, NC • On-site

$16.25 - $21.75/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 16 days ago

Key responsibilities

  • Verify surgical authorizations according to established policies and procedures.

  • Compile statistical data and assist with insurance audits.

  • Assist with reception and admission needs as necessary.

Job description

North Carolina Specialty Hospital (NCSH) is a private, physician-owned medical center that opened its doors in 1926. Its commitment to growth and continuous improvement has helped the hospital maintain a high ranking in both quality measures and patient satisfaction. North Carolina Specialty Hospital offers surgical specialties in orthopedics, ophthalmology, ear, nose, and throat, as well as sports medicine, oral, plastic, podiatry, general surgery, interventional radiology, pain management, reconstructive surgery, and more.
Why join North Carolina Specialty Hospital?
  • Award Winning Hospital for Special Surgery
  • 5 Star CMS rated facility for patient experience
  • Positive Work culture
  • Career growth opportunities
  • Comprehensive Medical, Dental, Vision Insurance, Life and Disability Insurance
  • Telemedicine/You have access to Physicians 24/7/365 through MDLIVE
  • Paid Time Off
  • 401k Employer Match
  • Tuition Assistance

JOB TITLE: Authorization & Health Information Specialist
GENERAL SUMMARY OF DUTIES:
Under the direction of the Admitting and Health Information manager, this position is responsible for verifying surgical authorizations, assisting with Performance Improvement projects, compiling statistical data, and insurance audits. In addition, the position will assist with other admission and reception duties as needed. Anticipate the needs of customers and work proactively to improve services. Work with others to improve customer satisfaction and participates in special projects as needed.
ESSENTIAL FUNCTIONS:
  • Verifies surgical authorizations according to established policies and procedures
  • Compiling statistical Data and assisting with insurance audits
  • Assists with reception and admission needs as necessary.
  • Follows all applicable laws and regulations regarding the release of information and the maintenance of medical records, including those that relate to the age and legal status of the patient.
  • Prioritizes work assignments and accomplishes tasks accurately and in a timely manner.
  • Utilizes automated processes and clinical information systems appropriately and efficiently.
  • Utilizes concepts of age/developmental stages in interactions with patients and families.
  • Adheres to all Hospital Policies and Procedures, specifically Guidelines for Appropriate Conduct, Corporate Compliance, Diversity, and Confidentiality.
  • Identifies potential risks to patients: identifies risks to patients in order to reduce incidence of injury; identifies actions to eliminate, minimize or report risks; identifies procedures to follow in the event of an incident; reports processes for common problems, failures and user errors.
  • Demonstrates the spirit of the philosophy, mission, and values of the hospital through words and actions and implements them into departmental processes, programs, and the working environment.
  • Applies the principles and values of customer service and continuous quality improvement while performing day-to-day activities of the position.
  • Maintains and protects confidentiality regarding all aspects of patient care, personnel and strategic issues.
  • Adheres to Confidentiality Policy.
  • Maintains positive working relationships and fosters cooperative work environment.
  • Adheres to the hospital's "Guidelines for Appropriate Conduct" in the HR Manual.
  • Displays honesty and mutual respect when communicating with peers and other departments.
  • Follows through on problems that may compromise effective job performance by using appropriate chain of command.
  • Complies with National Patient Safety Goals.
  • Universal precautions and infection control guidelines, including hand washing guidelines followed at all times.
  • Performs other duties as required or assigned, which are reasonably within the scope of duties in this job classification
  • Ability to work independently to meet established deadlines
  • Ability to make sound reasonable decisions
  • Demonstrates respect for diverse backgrounds of all patients, families and co-workers.
  • Seeks guidance, direction and assistance when needed.

EDUCATION:
  • High School or equivalent

EXPERIENCE:
  • Surgical authorization experience is required

SKILLS, KNOWLEDGE AND ABILITIES:
  • Effective communication skills; both orally and written.
  • Highly organized.
  • Computer skills needed.
  • Ability to work with others within a team to ensure quality patient care.
  • Strong problem-solving skills.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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