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Tricare Prior Authorization Jobs (NOW HIRING)

St. Joseph's/Candler

VA Auditing Specialist

Savannah, GA · On-site

$19.28/hr

... obtaining necessary prior authorizations for medical services from insurance companies, by ... While auditing for accuracy and validity of all authorizations or referrals for VA and Tricare. The ...

St. Joseph's/Candler

VA Auditing Specialist

Savannah, GA · On-site

$19.28/hr

... obtaining necessary prior authorizations for medical services from insurance companies, by ... While auditing for accuracy and validity of all authorizations or referrals for VA and Tricare. The ...

St. Joseph's/Candler

VA Auditing Specialist

Savannah, GA · On-site

$19.28/hr

... obtaining necessary prior authorizations for medical services from insurance companies, by ... While auditing for accuracy and validity of all authorizations or referrals for VA and Tricare. The ...

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Tricare Prior Authorization information

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$32

How much do tricare prior authorization jobs pay per hour?

As of Sep 13, 2026, the average hourly pay for tricare prior authorization in the United States is $20.89, according to ZipRecruiter salary data. Most workers in this role earn between $17.31 and $23.08 per hour, depending on experience, location, and employer.

What is Tricare prior authorization?

Tricare prior authorization is a process where your healthcare provider must obtain approval from Tricare before certain services, prescriptions, or procedures are covered. This helps ensure that the requested care is medically necessary and appropriate for your situation. Without prior authorization, Tricare may not cover the cost of the service, leaving you responsible for the bill. It's important to check with your provider and Tricare before receiving any care that might require authorization to avoid unexpected expenses.

What are some common challenges faced in a Tricare prior authorization role, and how can they be managed effectively?

Professionals in a Tricare Prior Authorization role often encounter challenges such as navigating complex insurance guidelines, ensuring timely approval of medical services, and communicating effectively with healthcare providers, patients, and insurers. Managing these challenges involves staying up-to-date with Tricare policies, utilizing strong organizational and problem-solving skills, and maintaining clear, compassionate communication to address any documentation gaps or denials. Collaborating closely with clinical staff and leveraging electronic health record systems can also streamline the authorization process and improve outcomes for both patients and providers.

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

To thrive as a Tricare Prior Authorization Specialist, you need a strong understanding of healthcare insurance processes, medical terminology, and Tricare guidelines, often supported by experience in medical billing or a related certification. Familiarity with prior authorization software, electronic health records (EHR) systems, and claims processing platforms is typically required. Attention to detail, strong organizational skills, and effective communication are crucial soft skills for coordinating with providers, patients, and insurance representatives. These competencies ensure timely and accurate authorization of services, minimizing delays in patient care and ensuring compliance with Tricare policies.

What is the difference between Tricare Prior Authorization vs Medical Billing Specialist?

AspectTricare Prior AuthorizationMedical Billing Specialist
CredentialsTypically requires knowledge of Tricare policies, healthcare regulationsCertification in medical billing or coding often preferred
Work EnvironmentHealthcare facilities, insurance companies, government agenciesMedical offices, hospitals, billing companies
Industry UsageMilitary healthcare, insurance processingHealthcare revenue cycle management

While Tricare Prior Authorization involves obtaining approval for military healthcare services, Medical Billing Specialists handle billing and coding processes. Both roles require healthcare industry knowledge but focus on different aspects of patient care and administrative tasks.

What other helpful pages are available for Tricare Prior Authorization?

Other pages related to Tricare Prior Authorization:

Infographic showing various Tricare Prior Authorization job openings in the United States as of September 2026, with employment types broken down into 100% Full Time. Highlights an 89% In-person, and 11% Remote job distribution, with an average salary of $43,459 per year, or $20.9 per hour.

Billing Specialist

Burlington, NC • On-site

Burlington/Mebane Pediatrics PA
See more jobs at Burlington/Mebane Pediatrics PAexternal

$16 - $21.75/hr

Full-time

Medical

Posted 11 days ago

Key responsibilities

  • Manage medical claims for Aetna, CHAMPVA, MedCost, and TRICARE, including verifying insurance eligibility and benefits.

  • Post insurance payments, contractual adjustments, denials, and patient responsibility accurately, and review remittance information for discrepancies.

  • Serve as an escalation resource for mental and behavioral health eligibility, benefits, and prior authorization requirements.

Job description

Burlington Pediatrics is seeking an experienced and detail-oriented Billing Specialist – Medical & Integrated Care to join our billing team.

This position will have primary responsibility for medical insurance billing, payment posting, and insurance follow-up, with a strong focus on Aetna, CHAMPVA, MedCost, and TRICARE. The Billing Specialist will also serve as an internal Integrated Care resource for mental and behavioral health eligibility and benefits escalation, and prior authorization requirements.

Key Responsibilities

Medical Insurance Billing & Follow-Up

  • Manage medical claims for Aetna, CHAMPVA, MedCost, and TRICARE.
  • Verify insurance eligibility, benefits, deductibles, copays, coinsurance, and coverage limitations.
  • Research and resolve claim rejections, denials, and underpayments.
  • Submit corrected claims, reconsiderations, and appeals.
  • Monitor claims for timely filing and proper reimbursement.
  • Follow up with insurance companies on outstanding claims and accounts receivable.
    • Insurance Payment Posting
  • Post insurance payments, contractual adjustments, denials, and patient responsibility accurately.
  • Review EOBs, ERAs, and remittance information for accuracy.
  • Identify incorrect payments, missing payments, and underpayments.
  • Research discrepancies between payments received and expected reimbursement.
  • Ensure payments and adjustments are posted to the appropriate patient accounts and dates of service.
  • Identify recurring payment or reimbursement issues and communicate trends to management.

    • Integrated Care – Mental & Behavioral Health Resource

  • Serve as the escalation resource for mental and behavioral health eligibility and benefits questions.
  • Research behavioral health coverage, copays, deductibles, coinsurance, visit limits, and exclusions.
  • Determine whether mental and behavioral health services require prior authorization or referrals.
  • Obtain and track behavioral health prior authorizations.
  • Research payerspecific requirements for psychotherapy, nutritional, behavioral health, integrated care, and telehealth services.
  • Assist staff with complex behavioral health insurance questions and billing issues.
  • Communicate insurance requirements clearly to providers, clinical staff, frontoffice staff, and the billing team.
    • Prior Authorizations
  • Obtain and track medical and behavioral health authorizations.
  • Monitor authorization numbers, effective dates, approved services, and visit limits.
  • Follow up on pending or denied authorization requests.
  • Research authorizationrelated claim denials and determine appropriate resolution.
    • Qualifications
  • Minimum 2 years of medical billing experience.
  • Strong experience with insurance eligibility, benefits, claims, payment posting, and A/R.
  • Experience with Aetna, CHAMPVA, MedCost, and TRICARE strongly preferred.
  • Behavioral/mental health billing experience strongly preferred.
  • Experience with NC Medicaid and commercial insurance.
  • Experience with prior authorizations, denials, appeals, and corrected claims.
  • Knowledge of CPT, HCPCS, ICD10, modifiers, and place of service codes.
  • Strong attention to detail and organizational skills.
  • Excellent problemsolving and criticalthinking abilities.
  • Strong written and verbal communication skills.
  • Ability to manage a high volume of claims and payments while maintaining accuracy.

    • Pediatric billing experience, behavioral/mental health billing experience, and Office Practicum experience are a plus.

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