Hybrid Prior Authorization Specialist: Support Care Access

TalentLNX; Pittsburgh (Allegheny County); Hybrid; USD 48,000 - 58,000; Full time

Job summary

TalentLNX is seeking a Prior Authorization Specialist for the Greater Pittsburgh area. This full-time role combines on-site work with regular remote work, handling submissions, calls, and patient communication to start care without delay.

The ideal candidate has direct prior authorization experience and knowledge of payer requirements, plus strong organization and clear communication skills. Training on internal workflows is provided.

Qualifications

• Direct prior authorization experience in any pharmacy or healthcare setting.
• Knowledge of insurance coverage and payer requirements.
• Experience using payer portals and healthcare systems.
• Able to explain coverage clearly to patients.
• Comfort working 8:00 AM–8:00 PM EST, Monday–Friday.
• Resident within commuting distance of the Greater Pittsburgh area.

Responsibilities

• Submit prior authorization requests for medications, procedures, or other services to insurance plans.
• Handle inbound and outbound calls with payers, providers, 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, notes, and labs.
• Review payer criteria and ensure requests are complete and accurate before submission.
• Support appeals and reconsiderations for denied authorizations.
• Track authorization expirations and complete renewals before coverage lapses.
• Explain authorization status, coverage, and next steps clearly to patients.
• Keep providers and internal teams informed of case status.
• Escalate complex cases or payer issues to leadership promptly.
• Meet turnaround times and quality standards for each case.
• Maintain accurate records and HIPAA compliance.

Skills

Prior Authorization

Phone communication

Attention to detail

Customer service

Time management

Education

High school diploma or equivalent

Associate or Bachelor's degree preferred

Tools

Payer portals

Healthcare systems

Job description

TalentLNX is seeking a Prior Authorization Specialist for the Greater Pittsburgh area. This full-time role combines on-site work with regular remote work, handling submissions, calls, and patient communication to start care without delay.

The ideal candidate has direct prior authorization experience and knowledge of payer requirements, plus strong organization and clear communication skills. Training on internal workflows is provided.