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Remote Optum Prior Authorization Jobs in Missouri

Valeris

Remote Field Reimbursement Manager

Columbia, MO · Remote

As a Remote Field Reimbursement Manager you will help support patient access to critical therapies ... prior authorizations, appeals processes, and patient support financial assistance offerings. This ...

Jetset With J

Remote Travel Professional

Saint Louis, MO · Remote

$35K - $65K/hr

No prior travel industry experience is required. Comprehensive training, ongoing support, and ... Must be authorized to work in the United States What We Offer * 100% Remote work * Flexible ...

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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 are popular job titles related to Remote Optum Prior Authorization jobs in Missouri?

For Remote Optum Prior Authorization jobs in Missouri, the most frequently searched job titles are:

What job categories do people searching Remote Optum Prior Authorization jobs in Missouri look for?

The top searched job categories for Remote Optum Prior Authorization jobs in Missouri are:

What cities in Missouri are hiring for Remote Optum Prior Authorization jobs?

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

Remote Optum Prior Authorization jobs near you
Infographic showing various Remote Optum Prior Authorization job openings in Missouri as of August 2026, with employment types broken down into 80% Full Time, and 20% Part Time. Highlights an 100% Remote job distribution.

Authorization and Referral Coordinator

Compass Health Network

Clinton, MO • On-site, Remote

$17.89/hr

Full-time

Dental

Posted 14 days ago

Compass Health Network rating

6.8

Company rating: 6.8 out of 10

Based on 69 frontline employees who took The Breakroom Quiz

498th of 893 rated healthcare providers

Job description

Authorization and Referral Coordinator
Department: FQHC-Specific Administration
Employment Type: Full Time
Location: Any Compass Location
Reporting To: Jennifer Shirky
Compensation: $17.89 / hour
Description
The Authorization and Referral Coordinator - Dental plays an important role in supporting timely access to dental services by coordinating insurance verification, treatment estimates, referrals, and prior authorizations. Serving as a key connection point between patients, dental teams, specialty providers, and insurance carriers, this role helps ensure information is accurate, communication is clear, and patients understand their coverage and anticipated financial responsibility before receiving care.
Schedule: Monday - Friday 8:00am-4:30pm. *Remote position for Missouri Residents only.
This is a great opportunity for someone who enjoys bringing organization and clarity to complex processes, building positive relationships, and helping patients navigate the details that can impact their access to care. Your attention to detail and follow-through will help keep referrals and authorizations moving while supporting smooth, efficient dental clinic operations.
Key Responsibilities
  • Verify dental insurance benefits, coverage limitations, deductibles, exclusions, frequencies, and annual maximums.
  • Complete insurance verification and maintain accurate insurance and demographic information in the EHR.
  • Prepare treatment cost estimates and communicate anticipated patient financial responsibility in a clear, compassionate manner.
  • Coordinate internal and external dental referrals and prior authorizations, including gathering documentation and submitting required information to payers and specialty providers.
  • Track referrals and authorizations from submission through completion, providing timely follow-up and updates to patients, providers, and dental teams.
  • Coordinate specialty appointments, follow-up care, and documentation from external providers.
  • Collaborate closely with dentists, hygienists, dental assistants, front desk teams, insurance carriers, and specialty offices to keep care coordination moving forward.
  • Maintain organized, accurate insurance, referral, and authorization documentation.
  • Prepare and distribute pre-authorization status reports for dental leadership and assigned providers.
  • Support a positive patient experience through responsive communication, professionalism, and compassionate service.
  • Follow organizational policies, payer requirements, and HIPAA standards while supporting efficient clinic operations.

Requirements, Skills, Knowledge and Expertise
  • High School/GED required
  • Three (3) to five (5) years dental experience preferred
  • Bring strong attention to detail and take pride in accurate, organized work.
  • Enjoy coordinating multiple moving pieces and following tasks through to completion.
  • Communicate clearly and compassionately with patients, families, providers, and insurance representatives.
  • Are comfortable navigating insurance benefits, referrals, authorizations, and financial information-or are eager to build your expertise in these areas.
  • Approach patients with respect and a strengths-based mindset, recognizing their ability to make informed decisions about their care.
  • Thrive in a collaborative environment and enjoy being a reliable resource for both patients and your dental team.
  • Want your work to make a meaningful difference by helping people navigate the path to the dental care they need.

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