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Remote Optum Prior Authorization Jobs in Alabama

Billing Representative- Remote

Cullman, AL ยท On-site +1

$15.75 - $20.50/hr

Submit prior authorizations for State insurance * Interact with insurance company on daily basis, i.e., overrides, rejections, and insurance updates * Interact with client facilities staff, PDP ...

$35/hr

Must be legally authorized to work in the U.S. and not require employment-based sponsorship now or ... Prior exposure to claims databases (Medicare, MarketScan, Premier PINC AI, Optum) or EHR data ...

New

$35/hr

Must be legally authorized to work in the U.S. and not require employment-based sponsorship now or ... Prior exposure to claims databases (Medicare, MarketScan, Premier PINC AI, Optum) or EHR data ...

New

$35/hr

Must be legally authorized to work in the U.S. and not require employment-based sponsorship now or ... Prior exposure to claims databases (Medicare, MarketScan, Premier PINC AI, Optum) or EHR data ...

New

$35/hr

Must be legally authorized to work in the U.S. and not require employment-based sponsorship now or ... Prior exposure to claims databases (Medicare, MarketScan, Premier PINC AI, Optum) or EHR data ...

New

$35/hr

Must be legally authorized to work in the U.S. and not require employment-based sponsorship now or ... Prior exposure to claims databases (Medicare, MarketScan, Premier PINC AI, Optum) or EHR data ...

New

Valid work authorization in the country where the job is located is required.Successful candidates ... prior to their start date. This hiring process may utilize machine-based systems to assist in ...

Valid work authorization in the country where the job is located is required. Successful candidates ... prior to their start date. This hiring process may utilize machine-based systems to assist in ...

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Remote Optum Prior Authorization information

What is a Remote Optum Prior Authorization?

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.

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.

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.

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 cities in Alabama are hiring for Remote Optum Prior Authorization jobs?

Cities in Alabama with the most Remote Optum Prior Authorization job openings:

Infographic showing various Remote Optum Prior Authorization job openings in Alabama as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 21% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

Billing Representative- Remote

SPECIALTY RX, Inc.

Cullman, AL โ€ข On-site, Remote

$15.75 - $20.50/hr

Full-time

Posted 23 days ago


Job description

Description
At Specialty Rx, Inc., our mission is to provide exceptional service guided by our CARE culture - Commitment, Accountability, Respect, and Excellence. The highest priority of each employee is to deliver top-quality service to our customers and colleagues, whether directly or through supporting others. This job description outlines the primary responsibilities through which employees embody our CARE values and contribute to the company's mission of outstanding service.
Responsibilities:
  • Perform duties assigned by the Billing Supervisor
  • Research and establish patient eligibility coverage with insurance providers (state and private)
  • Determine and process insurance rejections in accordance with the daily report
  • Maintain and update patient billing and insurance information in the system
  • Submit prior authorizations for State insurance
  • Interact with insurance company on daily basis, i.e., overrides, rejections, and insurance updates
  • Interact with client facilities staff, PDP (Medicare), CMS, NJM and NYM, if necessary
  • Follow up and resolved pending billing issues

Qualifications:
  • H.S. diploma or equivalent
  • Third party rejections required
  • Experience in Long Term Care Pharmacy preferred
  • Experience in New York Pharmacy billing claims preferred
  • Courteous and polite phone skills
  • Computer literate
  • Previous experience in pharmacy
  • Must be able to work independently and as a team
  • Ability to multitask and work in a fast-paced environment a must
  • Frameworks/ECM knowledge a plus
  • Must be detail oriented

Schedule:
Flexible with the hours and the ability to work nights and weekends is a must.
  • 8am - 4pm
  • 9am - 5pm
  • 11am - 7pm
  • 12pm - 8pm
  • 3pm - 11pm
  • 4pm - 12am

EEO Statement, SpecialtyRx, Inc. is fully committed to employing a diverse workforce. We recruit and retain talented individuals without regard to gender, race, age, marital status, disability, veteran status, sexual orientation and gender identity or any other status protected by federal, state, or local law.
EO/Minorities/Females/Disabled/Veterans