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What does a Prior Authorization Specialist do?

A prior authorization specialist assists patients who need treatment requiring insurance carrier pre-authorization. They interview patients to assess their medication needs and liaise with insurance companies and nurse managers for prior authorization approval. Prior authorization specialists usually work in medical clinic billing offices and insurance companies. With further education, prior authorization specialists may become pharmacists.


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Working as a Prior Authorization Specialist

Prior authorization specialists usually:

  • Discuss medications, insurance and prior authorization documents with patients.
  • Get prior authorization approval from insurance firms and nurse managers.
  • Appeal insurance companies after prior authorization refusals.
  • Assess accounts for completeness and accuracy.
  • Follow up on missing or incorrect information so patients receive the right reimbursement.
  • Document account activity using correct medical and billing codes.
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How much does a Prior Authorization Specialist make in the United States?

Average base salary

Average $18.77
Low $12.03
High $29.30
Non-cash benefit
View more benefits

The average salary for a prior authorization specialist is $18.77 per hour in the United States. 1.5k salaries reported, updated at July 1, 2022.

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Where can a Prior Authorization Specialist earn more?

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How much do similar professions get paid in United States?

Care Coordinator

21,423 job openings

Average $19.38 per hour

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Common questions about for a Prior Authorization Specialist

What is a prior authorization specialist's work schedule like?

Most prior authorization specialists work full-time hours on weekdays. Weekend, public holiday and overtime work is rare.

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What is a prior authorization specialist's work environment like?

Working as a prior authorization specialist involves hours spent at a desk interviewing patients, making phone calls and sending and returning emails. Travel is rare, although they may travel between branches if they work for a large organization.

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