Top 499 Prior authorization Jobs in North Carolina

Prior Authorization Specialist
Empowered Arthritis and Rheumatology Center PLLC —Cary, NC
- $23 - $28 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
11d
Authorization and Appeals Specialist
The Palomino Group —North Carolina
- From $23 an hour
- Full-time
- Background check
- Microsoft Excel
- Microsoft Outlook
- Disability insurance
- Health insurance
Quick Apply
8d
Authorization Specialist
EMERGEORTHO, P.A. —Wilmington, NC
- Full-time
- Mid-level
- High school diploma or GED
- Organizational skills
- Health savings account
- Paid holidays
Quick Apply
14d
Pharmacy Care Representative - Work From Home North Carolina
CVS Health —North Carolina
- $17.00 - $25.65 an hour
- Overtime
- Remote
- Microsoft Excel
- Microsoft Outlook
- Windows
- Paid training
- Paid holidays
6d
Care Manager I-Non-Waiver (Full Time, Hybrid, Mecklenburg County, North Carolina Based)
Alliance Health —Charlotte, NC
- $28.96 - $37.65 an hour
- Full-time
- Hybrid work
- LMFT
- Nursing
- Microsoft Excel
- Disability insurance
- Health insurance
1d
Triage Medical Assistant or Licensed Practical Nurse
Wilmington Gastroenterology —Wilmington, NC
- $17 - $25 an hour
- Urgently hiring
- Private practice
- Blood sampling
- Medical office experience
- Health insurance
- Dental insurance
Quick Apply
12d
Certified Medical Assistant
Coastal Carolina Health Care, P.A. —New Bern, NC
- Full-time
- Background check
- Vital signs
- RN License
- Health insurance
- Dental insurance
Quick Apply
13d
Biologics Coordinator
Charlotte Gastroenterology & Hepatology —Huntersville, NC
- Full-time
- High school diploma or GED
- In-person
- Associate's degree
- Profit sharing
- Health savings account
Quick Apply
Certified Medical Assistant - Orthopaedics
Duke Health —Durham, NC
- Full-time
- Vital signs
- Heavy lifting
- BLS Certification
- Relocation assistance
Registered Nurse-Special Procedures (South Park)
Carolina Asthma & Allergy Center —Charlotte, NC
- $28 - $34 an hour
- Full-time
- Nursing
- Vital signs
- RN License
- Health savings account
- Health insurance
Quick Apply
7d
Certified Medical Assistant - ENT
Duke Health —Durham, NC
- Full-time
- Vital signs
- BLS Certification
- No experience needed
Certified Pharmacy Tech - Hybrid (PTCB REQUIRED)
CornerStone Medical —Cary, NC
- $22 an hour
- Online Application
- Pass drug screening
- Mid-level
- Criminal background check
Quick Apply
23h
Registered Nurse (RN) Home Health-Weekends
Duke Health —Durham, NC
- Full-time
- CPR Certification
- Nursing
- Skilled nursing facility
- Mileage reimbursement
Certified Medical Assistant - Urogynecology
Duke Health —Durham, NC
- Full-time
- Vital signs
- BLS Certification
- Outpatient experience
- Relocation assistance
12d
Medical Assistant Asheville
Blue Sky MD —Asheville, NC
- From $21 an hour
- Full-time
- Blood sampling
- Vital signs
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Healthcare Solutions Analyst (EHR/EMR Experience Required)
PAI3 —Cary, NC
- $42,000 - $72,000 a year
- Full-time
- Mid-level
- Office
- 3 years
Quick Apply
Care Manager - LP (Cherokee County, NC)
Vaya Health —North Carolina
- $62,993.84 - $75,000.00 a year
- Full-time
- LMFT
- Nursing
- Microsoft Excel
Care Manager - LP (Henderson County, NC)
Vaya Health —Hendersonville, NC
- $62,993.84 - $75,000.00 a year
- Full-time
- LMFT
- Nursing
- Microsoft Excel
Case Manager (RN) Home Health
Duke Health —Durham, NC
- 8 hour shift
- CPR Certification
- Nursing
- Skilled nursing facility
- Mileage reimbursement
- Relocation assistance
Registered Nurse ($2K Sign-On Bonus)
Oak Street Health —High Point, NC
- $54,095 - $116,760 a year
- Full-time
- RN License
- BLS Certification
- Clinic experience
- Health insurance
- Dental insurance

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Prior Authorization Specialist

Empowered Arthritis and Rheumatology Center PLLC
Cary, NC

Quick Apply

Job Details

Full-time
$23 - $28 an hour
11 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance
Professional development assistance

Qualifications

Appeals
Teamwork
Microsoft Excel
Medical documentation
Microsoft Outlook
Overseeing health insurance pre-certification
Patient service
High school diploma or GED
Medical billing discrepancy resolution
Case appeal in utilization management
Attention to detail
Clinical documentation
Care coordination
Insurance claims appeal handling
Medical billing insurance follow-up

Full Job Description

Prior Authorization Specialist

Specialty Medications / Biologics - Rheumatology

Reports To: Practice Administrator

Work Schedule: Monday – Friday, 8:00 AM – 5:00 PM (1-hour lunch break)

Location / Type: On-site, full-time

Position Summary

We are a Rheumatology practice with an on-site infusion suite, and we are looking for a Prior Authorization Specialist to keep our patients moving smoothly from prescription to treatment. In this role, you will own the prior authorization, benefit verification, and patient financial-assistance process for specialty and biologic medications, serving as the link between patients, providers, payers, specialty pharmacies, and drug manufacturers.

This is a great fit if you have prior authorization, benefit verification, or specialty pharmacy experience and want to grow into the specialty-drug and infusion space. You do not need a rheumatology background to apply. If you are strong on the prior authorization fundamentals, we will train you on our specialty workflows, payer rules, and the medications we use.

Key Responsibilities

Authorization & Access Management

Prepare and submit prior authorizations for specialty and biologic medications through payer portals and electronic prior authorization (ePA) platforms such as CoverMyMeds, SamaCare, or SureScripts.
Track approvals, work denials and appeals, and submit renewals before they expire.
Partner with providers to gather the clinical documentation each authorization needs (labs, step-therapy history, diagnosis codes).

Financial Coordination & Patient Support

Run benefit investigations to determine coverage under the medical vs. pharmacy benefit.
Enroll eligible patients in manufacturer copay assistance, bridge, and free-drug programs to reduce out-of-pocket cost.
Walk patients through their benefits, enrollment requirements, and the timeline to get their medication.

Billing, Coding & Revenue Cycle Support

Verify coverage and reimbursement parameters for buy-and-bill and specialty pharmacy fulfillment models.
Support billing staff with accurate CPT, ICD-10, and HCPCS coding for biologic administration and infusion services.
Review claim submissions through a clearinghouse tool, identify rejections and denials, and initiate resolution or rebill.
Track payer responses and reimbursement timelines so claims process accurately and on time.

Patient Education & Clinical Workflow

Educate patients on their biologic therapy - how it is administered (infusion or injection), the treatment schedule.
Coordinate with the infusion suite on scheduling, inventory availability, and authorization clearance.
Document all communications and actions in the EMR to keep records accurate and current.

Communication & Practice Coordination

Serve as the primary point of contact for patients, providers, insurers, and specialty pharmacies on biologic-therapy questions.
Act as the liaison between the clinical team, infusion suite, billing department, and pharmaceutical representatives for a coordinated patient experience.

Required Qualifications

We are looking for the prior authorization fundamentals below. If you have these, we will train you on the rheumatology and infusion specific parts of the role.

High school diploma or equivalent.
1–2+ years of experience in prior authorization, benefit verification, specialty pharmacy, or a medical-office revenue cycle role.
Hands-on experience with at least one electronic prior authorization platform or payer portal - for example CoverMyMeds, SamaCare, SureScripts, or a payer-specific portal.
Familiarity with insurance verification and working denials and appeals.
Comfortable documenting in an EMR (e.g., eClinicalWorks, Epic, Athenahealth, or NextGen).
Proficient with Microsoft Office (Word, Excel, Outlook).
Detail-oriented, organized, and dependable on follow-through, with strong written and verbal communication skills.
A compassionate, patient-focused approach to care coordination.

Preferred Qualifications

Any of these are a plus:

Prior experience as a Biologic Coordinator, Patient Access Specialist, Reimbursement Specialist, or in a manufacturer patient-support / hub role.
Rheumatology, dermatology, gastroenterology, or similar specialty experience.
Direct experience with specialty biologics such as Humira, Enbrel, Remicade, Actemra, Cimzia, or Stelara.
Working knowledge of CPT, ICD-10, and HCPCS (J-code) coding for specialty drugs and infusion services.
Experience with buy-and-bill reimbursement and infusion suite operations.
Experience with a clearinghouse tool such as TriZetto for tracking and resolving claim denials.
Licensure or certification such as LPN, CMA, RMA, or CPhT.

Why Join Us

Specialized, in-demand skills: you will deepen your expertise in specialty drugs, infusion, and buy-and-bill reimbursement gaining a strong growth path in healthcare revenue cycle and patient access.
Predictable weekday schedule with no nights or weekends.
A collaborative team that supports patients through some of the most meaningful moments in their treatment.

Pay: $23.00 - $28.00 per hour

Benefits:

Dental insurance
Health insurance
Paid time off
Professional development assistance
Vision insurance

Work Location: In person

Quick Apply

Refine Your Search

prior authorization jobs in north carolina

Prior Authorization Specialist

Authorization and Appeals Specialist

Authorization Specialist

Pharmacy Care Representative - Work From Home North Carolina

Care Manager I-Non-Waiver (Full Time, Hybrid, Mecklenburg County, North Carolina Based)

Triage Medical Assistant or Licensed Practical Nurse

Certified Medical Assistant

Biologics Coordinator

Certified Medical Assistant - Orthopaedics

Registered Nurse-Special Procedures (South Park)

Certified Medical Assistant - ENT

Certified Pharmacy Tech - Hybrid (PTCB REQUIRED)

Registered Nurse (RN) Home Health-Weekends

Certified Medical Assistant - Urogynecology

Medical Assistant Asheville

Healthcare Solutions Analyst (EHR/EMR Experience Required)

Care Manager - LP (Cherokee County, NC)

Care Manager - LP (Henderson County, NC)

Case Manager (RN) Home Health

Registered Nurse ($2K Sign-On Bonus)

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