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Prior Authorization Jobs in Rochester, NY (NOW HIRING)

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Prior Authorization information

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$13

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$31

How much do prior authorization jobs pay per hour?

As of Jul 12, 2026, the average hourly pay for prior authorization in Rochester, NY is $20.62, according to ZipRecruiter salary data. Most workers in this role earn between $17.07 and $22.79 per hour, depending on experience, location, and employer.

How to become a prior authorization specialist?

To become a prior authorization specialist, candidates typically need a high school diploma or equivalent, along with experience in healthcare or insurance billing. Relevant skills include knowledge of medical terminology, insurance policies, and proficiency with electronic health record (EHR) systems; certifications such as Certified Professional Coder (CPC) can enhance job prospects.

What jobs pay $4000 a week without a degree?

Jobs that can pay $4,000 a week without a degree include certain sales roles, real estate agents, commercial pilots, and skilled trades such as electricians or plumbers with experience. These positions often require specialized skills, certifications, or licensing but do not necessarily require a college degree. High earnings typically depend on experience, performance, and the industry environment.

How much do precertification specialists make?

Precertification specialists typically earn between $35,000 and $55,000 annually, depending on experience, location, and employer. They often require knowledge of insurance policies and medical billing systems, and some roles may offer additional benefits or bonuses.

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 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 typically 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 Rochester, NY? The most popular types of Prior Authorization jobs in Rochester, NY are:
What are popular job titles related to Prior Authorization jobs in Rochester, NY? For Prior Authorization jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Prior Authorization jobs in Rochester, NY look for? The top searched job categories for Prior Authorization jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Prior Authorization jobs? Cities near Rochester, NY with the most Prior Authorization job openings:
Prior Authorization jobs near you
Infographic showing various Prior Authorization job openings in Rochester, NY as of July 2026, with employment types broken down into 74% Full Time, and 26% Part Time. Highlights an 95% In-person, and 5% Remote job distribution, with an average salary of $42,880 per year, or $20.6 per hour.
Medication Authorization Specialist

Medication Authorization Specialist

Rochester Regional Health

Rochester, NY • On-site

$18 - $25/hr

Part-time

Re-posted 11 days ago

Rochester Regional Health rating

7.4

Company rating: 7.4 out of 10

Based on 216 frontline employees who took The Breakroom Quiz

263rd of 881 rated healthcare providers

Job description

  • Job Title: Medication Authorization Specialist
    Location: Rochester General MOB (1415 Portland Avenue, Rochester, NY 14621)
    Department: Pharmacy
    Hours Per Week: 20 Hours, Part-time
    Schedule: Monday, Tuesday and Thursday 8a-4p or 8:30a-5p
    Key Responsibilities:
    • Coordinate and submit medication prior authorization requests to insurance companies, ensuring timely approvals.
    • Monitor, track, and follow up on prior authorizations, step therapy requirements, and appeals processes.
    • Communicate with providers to obtain necessary clinical documentation for insurance submissions.
    • Assist patients in applying for pharmaceutical assistance foundation programs, grants, and/or co pay programs
    • Maintain up-to-date knowledge of manufacturer support programs and eligibility requirements.
    • Track patient enrollment status and renewal needs for financial programs.
    • Contact patients to explain coverage decisions, out-of-pocket costs, and available financial options.
    • Provide empathetic, patient-centered support to help navigate financial barriers to care.
    • Serve as a key point of contact for patients regarding their cardiology medication access issues.
    • Document all activities accurately and timely in the Electronic Health Records (EHR)
    • Work collaboratively with physicians, nurses, pharmacists, and administrative staff to streamline access workflows.
    • Participate in process improvement initiatives to enhance patient experience and medication access efficiency.
    • All other duties as assigned.

    Preferred Qualifications:
    • Associates Degree in healthcare administration or business preferred.
    • Experience with prior authorizations, pharmacy or specialty medications preferred.
    • Proficiency in electronic medical records (EMR) systems and Microsoft Office applications.
    • Excellent communication skills including both oral and written as well as interpersonal skills.
    • Ability to handle simultaneous tasks paying great attention to detail.
    • Flexibility and ability to work as a team player.
    • Understanding of managed care, formularies, and payer policies.
    • Experience with Electronic Health Records (EHR) systems.
    • Strong verbal and written skills for interacting with providers, patients, and insurers.
    • Ability to pay attention to detail and ability to manage high volumes of requests with accuracy.

    Minimum Qualifications:
    • 2 years work experience in a healthcare settings, medical billing, pharmacy, or insurance verification.

    Required Licensure/Certification:
    • N/A

EDUCATION:
LICENSES / CERTIFICATIONS:
PHYSICAL REQUIREMENTS:
M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.
Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.
PAY RANGE:
$18.00 - $25.00
CITY:
Rochester
POSTAL CODE:
14621
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.
Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.

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