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Become A Prior Authorization Specialist

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Working As A Prior Authorization Specialist

  • Interacting With Computers
  • Getting Information
  • Documenting/Recording Information
  • Organizing, Planning, and Prioritizing Work
  • Processing Information
  • Deal with People

  • Mostly Sitting

  • Repetitive

  • $33,040

    Average Salary

What Does A Prior Authorization Specialist Do At Highmark Health

* Performs management responsibilities including, but not limited to: hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity management.
* Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
* Ensures uniform core competencies among utilization management staff through ongoing training, education, inter-rater reliability testing, and performance monitoring, including a continual focus on the correct, efficient and thorough application of InterQual criteria and/or Milliman Care Guidelines (as applicable) and utilization of applicable software applications/tools to the fullest extent possible.
* Performs strategic planning for the department; accountable for the operational excellence of the unit, control of administrative and care cost initiatives, system development and delivery of high quality outcomes, compliance with all state and federal regulations that affect utilization management activities and any needed reporting in a complete and timely manner.
* Develops and periodically evaluates administrative policies and procedures for the area and reviews the policies and procedures at least on an annual basis.
* Ensures that utilization management requests are handled at the most appropriate staff level.
* Monitors, reports and controls departmental activities to optimize efficiency and effectiveness and improve outcomes for members.
* Maintains current knowledge of applicable CMS, state, local, and regulatory agency requirements and standards related to utilization management/utilization review or other areas of responsibility.
* Other duties as assigned or requested

What Does A Prior Authorization Specialist Do At Medimpact, Inc.

* Data entry of incoming MERFs as required.
* Maintain archived files of processed MERFs and responses/letters in a central location.
* Dispense MERF to appropriate PA Coordinator using established department policy and procedures in a timely manner or as needed.
* Distribute PA reports daily, weekly, and/or monthly to appropriate personnel.
* Support Customer Service department with administrative duties such as copying, filing, faxing, and interoffice mail delivery as needed.
* Fax verification and research to ensure accuracy of fax transmissions.
* Initiate PA letter print in MedAccess and create banner pages for production when an address banner is missing.
* Attend and participate in monthly staff meetings

What Does A Prior Authorization Specialist Do At Robert Half

Assists with Medical Management processes

What Does A Prior Authorization Specialist Do At Kforce

Process and finalize PA requests within clients' turnaround time (TAT) and Performance Guarantees (PGs) utilizing guidelines; enter prior authorizations (Pas) into the system and prioritize requests

What Does A Prior Authorization Specialist Do At University of Rochester


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How To Become A Prior Authorization Specialist

High school graduates who have experience using computer software applications, such as word processing and spreadsheets, usually qualify for entry-level positions. Although most secretaries learn their job in several weeks, many legal and medical secretaries require additional training to learn industry-specific terminology. Executive secretaries usually need several years of related work experience.


High school graduates can take courses in word processing and office procedures at technical schools or community colleges. Some temporary placement agencies also provide training in word processing, spreadsheet, and database software.

Some medical and legal secretaries learn industry-specific terminology and practices by attending courses offered at community colleges or technical schools. For executive secretary positions, employers increasingly prefer to hire those who have taken some college courses or have a bachelor’s degree.


Secretaries and administrative assistants typically learn their skills through short-term on-the-job training, usually lasting a few weeks. During this time they learn about administrative procedures, including how to prepare documents. Medical and legal secretaries’ training may last several months as they learn industry-specific terminology and practices.

Work Experience in a Related Occupation

Executive secretaries can gain experience by working in administrative positions that have less challenging responsibilities. Many secretaries and administrative assistants advance to higher level administrative positions.

Licenses, Certifications, and Registrations

Although not required, certification can demonstrate competency to employers.

The International Association of Administrative Professionals offers the Certified Administrative Professional (CAP) certification. Candidates must have a minimum of 2 to 4 years of administrative work experience, depending on their level of education, and pass an examination.

Legal secretaries have several certification options. For example, those with 1 year of general office experience, or who have completed an approved training course, can acquire the Accredited Legal Professional (ALP) certification through a testing process administered by NALS (previously known as National Association of Legal Secretaries). NALS also offers the Professional Legal Secretary (PLS) certification, considered to be an advanced certification for legal support professionals.

The Certified Legal Secretary Specialist (CLSS) certification is conferred by Legal Secretaries International in areas such as intellectual property, criminal law, civil litigation, probate, and business law. Candidates typically need to have 5 years of legal experience and pass an examination to become certified.


Secretaries and administrative assistants generally advance to other administrative positions with more responsibilities, such as office supervisor, office manager, or executive secretary.

With additional training, many legal secretaries become paralegals or legal assistants.

Important Qualities

Integrity. Many secretaries and administrative assistants are trusted to handle sensitive information. For example, medical secretaries collect patient data that is required, by law, to be kept confidential in order to protect patient privacy.

Interpersonal skills. Secretaries and administrative assistants interact with clients, customers, or staff. They should communicate effectively and be courteous when interacting with others to create a positive work environment and client experience.

Organizational skills. Secretaries and administrative assistants keep files, folders, and schedules in proper order so an office can run efficiently.

Writing skills. Secretaries and administrative assistants write memos and emails when communicating with managers, employees, and customers. Therefore, they must have good grammar, ensure accuracy, and maintain a professional tone.

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Prior Authorization Specialist jobs

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Prior Authorization Specialist Career Paths

Prior Authorization Specialist
Case Manager Program Manager General Manager
Account Manager
5 Yearsyrs
Patient Care Coordinator Office Administrator Accounts Receivable Specialist
Accounts Receivable Manager
6 Yearsyrs
Team Leader Manager Office Manager
Billing Manager
7 Yearsyrs
Team Leader Human Resources Coordinator Business Office Manager
Business Office Director
8 Yearsyrs
Home Health Aid Unit Secretary Office Manager
Business Office Manager
8 Yearsyrs
Registered Nurse Case Manager Nursing Director Case Manager
Career Manager
6 Yearsyrs
Registered Nurse Case Manager Clinical Manager
Clinical Director
9 Yearsyrs
Home Health Aid Licensed Practical Nurse Staff Nurse
Clinical Manager
8 Yearsyrs
Clinical Pharmacist Operations Manager Assistant Director
Director Of Admissions
7 Yearsyrs
Office Assistant Legal Assistant Assistant Office Manager
Executive Assistant/Office Manager
6 Yearsyrs
Medical Coder Adjunct Instructor Assistant Professor
Medical Director
9 Yearsyrs
Case Manager Program Coordinator Assistant Director
Office Manager
5 Yearsyrs
Patient Care Coordinator Nurse Manager Registered Nurse Case Manager
Patient Care Manager
9 Yearsyrs
Clinical Pharmacist Clinical Coordinator Practice Manager
Practice Administrator
10 Yearsyrs
Accounts Receivable Specialist Accounts Receivable Manager Office Manager
Practice Manager
9 Yearsyrs
Office Assistant Office Manager Billing Manager
Revenue Manager
8 Yearsyrs
Medical Coder Auditor Operations Manager
Service Director
9 Yearsyrs
Accounts Receivable Specialist Finance Analyst Operations Manager
Site Manager
7 Yearsyrs
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Prior Authorization Specialist Demographics


  • Female

  • Male

  • Unknown



  • White

  • Hispanic or Latino

  • Asian

  • Unknown

  • Black or African American

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Languages Spoken

  • Spanish

  • Romanian

  • Hindi

  • Chinese

  • German

  • Samoan

  • Japanese

  • French

  • Amharic

  • Gujarati

  • Urdu

  • Arabic

  • Thai

  • Italian

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Prior Authorization Specialist

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Prior Authorization Specialist Education

Prior Authorization Specialist

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Top Skills for A Prior Authorization Specialist


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Top Prior Authorization Specialist Skills

  1. Participants Pharmacy Benefit
  2. Customer Service
  3. Insurance Companies
You can check out examples of real life uses of top skills on resumes here:
  • Rendered exceptional customer service and met volume deadlines and timetables.
  • Relocated to Indiana Obtained approval of medical testing requested by physicians by working with insurance companies, facilities, and patients.
  • Coordinated with medical offices to approve patients for prescription assistance program.
  • Provide guidance and direction to 5-person staff, accurately completing prior authorization requests for Medicaid services within time constraints.
  • Authorized requested services according to company guidelines, performed data entry into the authorization system, and verified eligibility.

Top Prior Authorization Specialist Employers

Prior Authorization Specialist Videos

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