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Remote Prior Authorization Jobs in Summit, NJ (NOW HIRING)

Capsule

Pharmacy Technician - NY Remote

New York, NY · On-site +1

$18 - $20.50/hr

Communicating via multiple mediums (phone, text, chat, email) with customers, external partners, and pharmacists to resolve any issues including prior authorizations and provide prescription updates ...

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All JobsPrior Authorization JobsRemote Prior Authorization JobsRemote Prior Authorization Jobs in Summit, NJ

Remote Prior Authorization information

See Summit, NJ salary details

$14

$22

$34

How much do remote prior authorization jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for remote prior authorization in Summit, NJ is $22.20, according to ZipRecruiter salary data. Most workers in this role earn between $18.41 and $24.52 per hour, depending on experience, location, and employer.

What is a remote prior authorization job?

Remote prior authorization jobs involve reviewing and processing requests from healthcare providers to determine if specific medical treatments, medications, or procedures are covered by a patient's insurance plan. Employees in these roles work from home, utilizing online systems to evaluate clinical information, communicate with providers, and ensure compliance with insurance policies. This position requires a strong understanding of medical terminology, insurance guidelines, and attention to detail to facilitate timely and accurate approvals or denials. Remote prior authorization specialists help streamline patient care by acting as a liaison between healthcare providers and insurance companies.

What are some common challenges faced by remote prior authorization specialists, and how can they be addressed?

Remote Prior Authorization specialists often encounter challenges such as navigating complex insurance requirements, managing high volumes of requests, and maintaining clear communication with healthcare providers and payers. Staying organized and up-to-date on payer policies is crucial, as requirements can vary widely between insurers. Utilizing workflow management tools and fostering strong collaboration with clinical and administrative teams can help streamline processes and reduce delays, ultimately ensuring patients receive timely care.

What are the key skills and qualifications needed to thrive as a remote prior authorization specialist, and why are they important?

To thrive as a Remote Prior Authorization Specialist, you need a solid understanding of medical terminology, insurance processes, and healthcare regulations, often supported by experience in medical billing or coding. Familiarity with electronic health record (EHR) systems, insurance portals, and prior authorization software is typically required. Attention to detail, strong organizational skills, and effective communication are crucial soft skills in this role. These skills ensure timely and accurate processing of authorizations, reducing claim denials and supporting efficient patient care.

What is the difference between Remote Prior Authorization vs Remote Medical Coder?

AspectRemote Prior AuthorizationRemote Medical Coder
Required CredentialsMedical credentials, insurance knowledgeMedical coding certification (CPC, CCS)
Work EnvironmentHealthcare offices, insurance companies, remoteHealthcare facilities, remote coding jobs
Industry UsageInsurance, healthcare providersHospitals, clinics, billing companies
Job FocusReviewing and approving insurance requestsTranslating medical records into codes

Remote Prior Authorization and Remote Medical Coder roles both operate within the healthcare industry but focus on different tasks. Remote Prior Authorization involves reviewing insurance requests for coverage approval, requiring insurance and medical knowledge. Remote Medical Coders translate medical records into standardized codes, primarily focusing on billing and documentation. Both roles can be performed remotely and require healthcare-related credentials, but their daily responsibilities and skill sets differ significantly.

What is a remote prior authorization job?

Remote prior authorization jobs focus on working with insurance companies to coordinate benefit coverage and get approval to provide care for a patient. In this pre-authorization role, you may collect documentation and proof of insurance, perform data entry, help evaluate the need for a particular process, and otherwise work from home to help manage the prior authorization process. Remote prior authorization personnel often answer telephone calls to provide consultations, perform initial benefit verification, document case status, actions, and outcomes in a database, and use customer service skills to help expedite cases as needed. Since this is a remote call center-style job, you may be asked to arrange for a quiet office in your house that is free of distractions.

More about Remote Prior Authorization jobs
What are the most commonly searched types of Prior Authorization jobs in Summit, NJ? The most popular types of Prior Authorization jobs in Summit, NJ are:
What job categories do people searching Remote Prior Authorization jobs in Summit, NJ look for? The top searched job categories for Remote Prior Authorization jobs in Summit, NJ are:
What cities near Summit, NJ are hiring for Remote Prior Authorization jobs? Cities near Summit, NJ with the most Remote Prior Authorization job openings:
Remote Prior Authorization jobs near you
Infographic showing various Remote Prior Authorization job openings in Summit, NJ as of August 2026, with employment types broken down into 89% Full Time, and 11% Contract. Highlights an 100% Remote job distribution, with an average salary of $46,180 per year, or $22.2 per hour.

Senior Specialist, Pharmacy Systems Operations - Remote

EmblemHealth

New York, NY • On-site, Remote

$68K - $118K/yr

Full-time

Re-posted 14 days ago

EmblemHealth rating

9.4

Company rating: 9.4 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

7th of 303 rated insurance

Job description

Summary of Job
Serve as pharmacy systems coding subject matter expert for Prior Authorization with a focus on medical drug claim processing, review of utilization management, PA processing, and appeals; as well as the following: claims processes and JUDI interoperability with FACETS edits and other connection troubleshooting. Provide technical and subject matter expertise support for implementations and day to day operations of Pharmacy functions and vendor coordination. Support operations for file transfer systems (configuration, deployment, pharmacy management and medical benefits, eligibility). Support operations for system integration, including monitoring files and transitions, fallout, and root cause analyses. Execute non-clinical Appeals from post claim edit process, and consistently maintain queue
Responsibilities
  • Collaborate in defining, gathering, reviewing, and editing business requirements for system updates, enhancements and migrations for claims projects.
  • Perform solution analysis review and provide concise direction to ensure that the proposed system solution meets established business protocols, and any mandates and compliance guidelines.
  • Partner with business analysts, business users and source system experts to produce claim processing output consistent with meeting overall goals.
  • Review daily, pended medical drug claims for accuracy.
  • Identify and implement solutions to support automation of claims or resolve with manual intervention.
  • Collaborate with clinical, formulary, payment integrity and other key players to ensure issues are accurately defined with an appropriate solution.
  • Submit and track medical claims system configuration requests related to RPC (Reimbursement Policy Committee) decisions, ensuring timely implementation and alignment with approved policy guidelines.
  • Work with business units to develop test strategies and scenarios from business requirements.
  • Accurately interpret and translate strategies and scenarios into test plans.
  • Analyze requirements, test documents and acceptance criteria which will effectively find defects that may exist in claims processing.
  • Act as a liaison and subject matter expert for day to day medical drug system-related technical questions and/or issues.
  • Troubleshoot and track all concerns on unpaid claims, working with key stakeholders and respond to all appropriate parties effectively within a timely manner.
  • Provide written progress report to leadership regarding the status of deliverables, issues, problems and corrective actions taken.
  • Perform other related tasks as directed or required

Qualifications
  • Bachelor's degree required
  • 4 - 6+ years of relevant, professional work experience (Required)
  • 2+ years' experience in one or more of the following: claims processing, pharmacy/coding, utilization management (Required)
  • Experience in a healthcare environment (Required)
  • Proficiency with MS Office - Word, Excel, Access, PowerPoint, Outlook (Required)
  • Advanced reporting system experience/knowledge - SAS, Oracle, etc. (Preferred)
  • Track record of successfully managing multiple tasks/projects with competing priority levels/deadlines (Required)
  • Ability to understand complex technical system requirements and translate into simple business language (Required)
  • Excellent communication skills - verbal, written, presentation, reporting, interpersonal (Required)
  • Attention to detail; ability to think critically; ability to identify, quantify, analyze and resolve issues (Required)

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