Prior authorization specialist resume examples from 2026
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How to write a prior authorization specialist resume
Craft a resume summary statement
A well-written resume summary is basically an elevator pitch. You are summing up your skills and experience in a few sentences to wow recruiters, hiring managers, and decision makers into giving you an interview. Here are some tips to putting your best foot first with your resume summary:
Step 1: Start with your current job title, or the one you aspire to. Are you a passionate manager? A skilled analyst? It's a good starting point.
Step 2: Next put your years of experience in prior authorization specialist-related roles.
Step 3: Now is the time to put your biggest accomplishment or something you are professionally proud of.
Step 4: Read over what you have written. It should be 2-4 sentences. Your goal is to summarize your experience, not recite your resume.
These four steps should give you a strong elevator pitch and land you some prior authorization specialist interviews.Please upload your resume so Zippia’s job hunt AI can draft a summary statement for you.
List the right project manager skills
Your Skills section is an easy way to let recruiters know you have the skills to do the job. Just as importantly, it can help your resume not get filtered out by hiring software. Here is how to make the most of your skills section and make sure you have the right keywords:
- Look at the job listing and skills listed. You need to include the exact keywords from the job description to get your resume in front of an actual human. Do you have those skills? Fantastic! Be sure to list them.
- Include as many relevant hard or technical prior authorization specialist skills as possible for each job you apply to.
- Be specific with the skills you have and be sure you are using the most up to date and accurate terms.
Here are example skills to include in your “Area of Expertise” on a prior authorization specialist resume:
- Patients
- Customer Service
- Medical Necessity
- Medical Terminology
- Clinical Resource
- Authorization Process
- Data Entry
- Utilization Management
- CPT
- Authorization Request
- Medicaid
- Appeals
- Patient Care
- Outbound Calls
- Phone Calls
- Home Health
- HIPAA
- Insurance Verification
- Inbound Calls
- EMR
- CMS
- ICD-10
- Medical Services
- Insurance Coverage
- Insurance Carriers
- InterQual
- Clinical Criteria
- Hippa
- Insurance Benefits
- Chemotherapy
Zippia’s AI can customize your resume for you.
How to structure your work experience
A work experience section is a vital part of your resume because it shows you have the experience to succeed in your next job.
- Put your most recent experience first. Prospective employers care about your most recent accomplishments the most.
- Put the job title, company name, city, and state on the left. Align dates in month and year format on the right-hand side.
- Include only recent, relevant jobs. This means if you're a fairly experienced worker, you might need to leave off that first internship or other positions in favor of highlighting more pertinent positions.
How to write prior authorization specialist experience bullet points
Your resume is not a list of responsibilities or a job description. Instead, it is your chance to show your accomplishments and show why you're good at what you do.
- Use the What, How, and Why format. Answering these questions turns a bland job description into an effective showcase of your abilities.
- What were your responsibilities or goals?
- How did you accomplish them?
- Why were your results important? (How did it impact your company? Can you quantify the results in numbers? )
Here are effective examples from prior authorization specialist resumes:
Work history example #1
Specialist
Westgate Resorts
- Iserved as the first point of contact for both the reservations department and front desk at the hotel and resorts.
- Contacted resorts and hotels to confirm customer's both arrival and departure dates.
- Gathered and verified all required information necessary to book or cancel reservations.
- Performed confidential verification of customer income status according to government procedures.
- Administered facility VIP tours, greeted and provided information to patrons and assisted executive patrons in club seat/suite area.
Work history example #2
Authorized Representative
C.H. Robinson
- Utilized CPR + to keep accurate information in patient's record.
- Requested authorizations for HMO patients for testing using ICD and CPT codes.
- Assisted patients with the interpretation of HMO, PPO, POS contractual agreements as well as Medicare and Medi-Cal guidelines.
- Requested outpatient hospital authorizations for radiology procedures including U/S, X-Ray, MRI, CT and PET scans.
- Utilized ICD-9 and ICD-10 codes for the descriptions of veterans.
Work history example #3
Patient Care Specialist
Scripps Health
- Trained new PSR's in all aspects of the position.
- Maintained confidentiality of patient health information in compliance with HIPAA regulations.
- Maintained patient records in accordance with HIPAA under the guidelines of the privacy act as well as Medicare/Medicaid guidelines.
- Verified Medicare, Medicaid, other government agencies and private insurance for new patients to determine their individualized eligibility and benefits.
- Managed carriers such as Medicare, Medicaid, and Commercial Insurances.
Work history example #4
Prior Authorization Specialist
HCA Healthcare
- Assisted with training and implementing new systems and procedures, acting team lead in absence of supervisor.
- Worked account to resolution for adjudication by contacting Medicare/Medicaid, BCBS, Cigna Aetna, UHC and many other insurance carrier.
- Educated and knowledgeable on how to adhere to all HIPPA guidelines.
- Documented patient s diagnosis (ICD-9 codes).
- Created the template for CPT handbook used by Pre-Authorization department.
Zippia’s AI can customize your resume for you.
Add an education section to your resume
The education section should display your highest degree first.
Place your education section appropriately on your resume. If you graduated over 5 years ago, this section should be at the bottom of your resume. If you just graduated and lack relevant work experience, the education section should go to the top.
If you have a bachelor's or master's degree, do not list your high school education. If your graduation year is more than 15-20 years ago, it's better not to include dates in this section.
Here are some examples of good education entries for resumes:
Bachelor's Degree in pharmacy
Texas Southern University, Houston, TX
2007 - 2010
Master's Degree in pharmacy
Remington College, Colorado Springs, CO
2012 - 2013
Highlight your prior authorization specialist certifications on your resume
If you have any additional certifications or education-like achievements, add them to the education section.
Start simple. Include the full name of the certification. It's also good to mention the organization that issued the certification. Next, specify when you obtained the certification.
If you have any of these certifications, be sure to include them on your prior authorization specialist resume:
- Certified Pharmacy Technician (CPhT)
- Medical Assistant
- Certified Billing and Coding Specialist (CBCS)
- Certified Medical Administrative Assistant (CMAA)
- Certified Specialty Pharmacist (CSP)
- Certified Medical Office Manager (CMOM)
- Pharmacy Technician
- Certified Coding Specialist (CCS)
- HIPAA Professional (HIPAAP)