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Remote Optum Prior Authorization Jobs (NOW HIRING)

1840 & Company

$16.75 - $22.25/hr

Prior Authorization Specialist We are seeking a detail-oriented and experienced Prior Authorization ... BPO) and remote talent solutions, dedicated to propelling businesses forward through our ...

CareMed Specialty Pharmacy

$23 - $25/hr

Pharmacy Prior Authorization Specialist - CareMed Specialty Pharmacy Buffalo, NY | Full-Time | ... Remote work possible after initial on-site training. Company Benefits * Medical; Dental; Vision ...

PainPoint

Prior Authorization Coordinator

Atlanta, GA · On-site +1

$19 - $21/hr

Prior Authorization Coordinator Full-Time | $19-21/hour | Monday-Friday | 8:00 AM-4:30 PM CST ... Remote About DxTx Pain & Spine At DxTx Pain & Spine, we're redefining how pain and spine practices ...

Managed Staffing

Prior Authorization Techician

RI · Remote

$21 - $22/hr

Fully Remote (U.S. based) - West Coast candidates preferred Seeking Pharmacy Technician I (Prior Authorization) professionals to join their remote Caremark team. This role is responsible for ...

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Remote Optum Prior Authorization information

What is the difference between Remote Optum Prior Authorization vs Remote Optum Claims Reviewer?

AspectRemote Optum Prior AuthorizationRemote Optum Claims Reviewer
CredentialsTypically requires healthcare-related certifications, such as RN, LPN, or medical coding credentialsOften requires similar healthcare certifications, with focus on claims processing
Work EnvironmentRemote, healthcare insurance setting, interacting with providers and patientsRemote, insurance claims processing environment, reviewing submitted claims
Employer & Industry UsageCommonly employed by health insurance companies like Optum, focusing on authorization processesEmployed by insurance companies, focusing on claims review and reimbursement

Remote Optum Prior Authorization specialists focus on obtaining approvals for healthcare services, while Remote Optum Claims Reviewers evaluate submitted claims for accuracy and reimbursement. Both roles require healthcare knowledge and certifications, but differ in their primary functions within the insurance process.

What is a Remote Optum Prior Authorization job?

A Remote Optum Prior Authorization job involves reviewing and processing requests from healthcare providers to determine whether certain medical procedures, medications, or services will be covered under a patient's insurance plan. Employees in this role work from home and use clinical guidelines to assess the necessity and appropriateness of requested treatments. They collaborate with providers, patients, and insurance teams to ensure timely authorization decisions. This position typically requires strong communication skills, attention to detail, and familiarity with healthcare regulations and insurance policies.

What are the key skills and qualifications needed to thrive as a Remote Optum Prior Authorization Specialist, and why are they important?

To thrive as a Remote Optum Prior Authorization Specialist, you need strong knowledge of medical terminology, insurance processes, and prior authorization protocols, typically supported by a healthcare-related degree or relevant experience. Familiarity with electronic health record (EHR) systems, insurance verification tools, and prior authorization software is essential. Excellent attention to detail, organizational skills, and effective communication are vital soft skills for efficiently managing high volumes of authorization requests and collaborating with providers. These skills ensure accurate, timely approvals and help optimize patient care while reducing administrative delays.

How does a Remote Optum Prior Authorization specialist typically interact with healthcare providers and insurance teams?

As a Remote Optum Prior Authorization specialist, you will regularly communicate with healthcare providers, pharmacies, and insurance representatives to obtain and verify necessary information for authorizing medical procedures or medications. Most interactions occur via phone, secure messaging, or electronic health record systems, requiring clear communication and attention to detail. Collaboration is essential, as you'll often need to clarify clinical documentation with providers and ensure compliance with insurance guidelines. This role is well-suited for those who are organized, proactive, and comfortable working independently within a supportive virtual team environment.
More about Remote Optum Prior Authorization jobs
What cities are hiring for Remote Optum Prior Authorization jobs? Cities with the most Remote Optum Prior Authorization job openings:
What are the most commonly searched types of Optum Prior Authorization jobs? The most popular types of Optum Prior Authorization jobs are:
What states have the most Remote Optum Prior Authorization jobs? States with the most job openings for Remote Optum Prior Authorization jobs include:
What job categories do people searching Remote Optum Prior Authorization jobs look for? The top searched job categories for Remote Optum Prior Authorization jobs are:
Remote Optum Prior Authorization jobs near you
Infographic showing various Remote Optum Prior Authorization job openings in the United States as of July 2026, with employment types broken down into 50% Part Time, and 50% Contract. Highlights an 100% Remote job distribution.

Prior Authorization Specialist

Inspire Medical Systems Inc.

Minneapolis, MN • Remote

$18.75 - $25/hr

Other

Posted 22 days ago

Job description

*Fully Remote Position*

ABOUT THIS POSITION  

We are recruiting for a Prior Authorization Specialist to join our team. In this role, you will be providing expertise in the area of prior authorization and will be responsible for implementing the Inspire Prior Authorization Program in the United States. You will be working with the Territory Managers and the prior authorization team to ensure all coding and coverage questions are answered correctly and concisely.

OPPORTUNITIES YOU WILL HAVE IN THIS ROLE  

  • Support Inspire's Prior Authorization Program, including:
    • Entering and managing patient information in database
    • Assisting with patient intake and verifying of insurance coverage
    • Calling insurances to obtain the status of Prior authorization requests
    • Working with patients and sites to pursue authorization success.
  • Assist in tracking and monitoring progress of prior authorization requests, along with all related appeals through to EMR.
  • Participate in updating the packet of materials and best practices methods to support the prior authorization and appeals processes, including External Medical Review, (EMR) for upper airway stimulation.
  • Seek continuous process improvement to increase success rates and reduce time to success.
  • Implement Inspire's Prior Authorization Program, including:
    • Training sites on program requirements
    • Entering and managing patient information in database
    • Completing prior authorization requests
    • Providing guidance to participating sites on all levels of appeals including EMR
    • Working directly with the patient to pursue EMR success.
  • Provide general coding information to physician customers upon request.
  • Work in conjunction with manager and staff to execute action plans and objectives to support internal/external clients.

QUALITY SYSTEM RESPONSIBILITIES

  • Document product and therapy related field reports within the prescribed timelines and provide any necessary documents required to complete the investigation. Provide follow-up reporting as needed.
  • Complete training requirements and competency confirmations as required for this position within the required timeline.
  • Comply with applicable quality system procedures/policies and make suggestions for continuous process improvement.

WHAT YOU CAN BRING TO OUR GREAT TEAM

Required: 

  • 2+ years of related work experience in reimbursement
  • Demonstrated knowledge of reimbursement compliance requirements and a maintaining a high level of personal integrity to promote a compliant reimbursement environment
  • Ability to read, interpret and appropriately respond to payer requirements relating to prior authorization
  • Ability to read, interpret and summarize clinical and cost literature
  • Excellent written and oral communication skills
  • Proficient in Microsoft Office applications, including Word, PowerPoint, Excel
  • High attention to detail and strong team attitude
  • Comfortable in a small, dynamic company environment with frequent changes in direction

Preferred: 

  • Bachelor's degree
  • Medical device experience

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