Prior Authorization Specialist

We are seeking a Prior Authorization Specialist to join a team within a healthcare organization in the Greater Pittsburgh area. In this role, you will submit and track prior authorizations, handle inbound and outbound calls with payers, providers, and patients, and help patients start care without delay. This position is a full time, direct hire opportunity with a hybrid schedule that combines on site work with regular remote work.

This opportunity is a great fit for a detail oriented healthcare professional who knows payer requirements and takes ownership of a case until it is resolved. Anyone with direct prior authorization experience is encouraged to apply, whether from a hospital, physician or specialty practice, health plan, pharmacy benefit manager, retail, specialty, or infusion pharmacy, hub services, home health, medical equipment, imaging, or another healthcare setting. Training on internal workflows and systems is provided. The ideal candidate is organized, persistent, and a clear communicator.

Responsibilities:

• Submit prior authorization requests for medications, procedures, or other services to insurance plans
• Handle a steady volume of inbound and outbound calls with insurance payers, provider offices, and patients
• Follow up with payers by phone and portal until a determination is received
• Verify patient eligibility and benefits before submitting requests
• Gather clinical documentation from provider offices, such as diagnosis codes, office notes, and lab results
• Review payer criteria and confirm requests are complete and accurate before submission
• Support appeals and reconsiderations for denied authorizations
• Track authorization expirations and complete renewals before coverage lapses
• Speak directly with patients and caregivers to explain authorization status, coverage, and next steps clearly and with empathy
• Keep providers and internal teams informed of case status
• Escalate complex cases or payer issues to leadership in a timely manner
• Meet established turnaround times and quality standards for each case
• Maintain accurate records in the system and follow HIPAA guidelines at all times

Qualifications:

• High school diploma or equivalent; associate or bachelor's degree preferred
• Direct prior authorization experience in any pharmacy or healthcare setting
• Working knowledge of insurance coverage and payer requirements
• Comfort working in payer portals and healthcare or pharmacy systems
• Comfort handling inbound and outbound calls and speaking directly with patients
• Strong phone presence and the ability to explain coverage in plain language
• Ability to manage a steady volume of cases while maintaining accuracy and meeting deadlines
• Comfortable working a scheduled shift within the operating hours of 8:00 AM to 8:00 PM EST, Monday through Friday
• Must reside within commuting distance of the Greater Pittsburgh area

Schedule:

• Full time, Direct Hire
• 40 hours per week, Monday through Friday
• Shifts are scheduled between 8:00 AM and 8:00 PM EST
• Hybrid schedule with regular remote work following an initial on site training period
• Reliable high speed internet and a private home workspace required for remote work

Salary Range:

The salary range for this position is approximately $47,840 to $58,240 annually ($23.00 to $28.00 per hour), based on experience and qualifications.

Interview Process:

Selected candidates will participate in a multi step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer:

TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law.