Prior Authorization Specialist

RemX | The Workforce Experts; Salt Lake City (UT); Hybrid; USD 68,770,000 - 80,231,000; Full time

Benefits offered by this job

Hybrid/Remote after training

Breakroom snacks

Business casual environment

Job summary

RemX | The Workforce Experts in Sandy, Utah is actively hiring 7-10+ Prior Authorization Specialists to support a growing healthcare team. This role focuses on accurate prior authorizations, insurance verification, benefits investigations, and appeals, with opportunities to grow into a hybrid or remote schedule.

You’ll join a professional environment, enjoy a supportive team, and receive training with the potential to transition to hybrid or remote work after six months.

Qualifications

• Experience in Insurance Verification or Benefits Investigation.
• Experience with Appeals and Denials preferred.
• Background in healthcare, medical office, or insurance.
• Strong attention to detail and documentation.
• Ability to interpret insurance policies.
• Experience navigating multiple payer systems.
• Excellent communication and customer service skills.
• Salesforce experience is a plus.

Responsibilities

• Process prior authorization requests accurately and efficiently.
• Review payer requirements, step therapy guidelines, and authorization criteria.
• Manage insurance denials and appeals following payer protocols.
• Verify insurance benefits and determine in-network vs out-of-network coverage.
• Evaluate medical and pharmacy benefits to determine patient eligibility.
• Analyze insurance policies and gather supporting documentation from providers.
• Communicate professionally with providers, patients, payers, and internal teams.
• Maintain timely and accurate documentation within Salesforce and other systems.
• Ensure compliance with payer regulations and internal quality standards.

Skills

Prior Authorization

Insurance Verification

Benefits Investigation

Appeals

Healthcare Administration

Tools

Salesforce

Job description

Salt Lake City (Sandy), Utah

Are you experienced in Prior Authorizations, Insurance Verification, Benefits Investigation, Appeals, or Healthcare Administration? We are actively hiring 7-10+ Prior Authorization Specialists to join a growing healthcare team in Sandy, Utah!

This is an excellent opportunity for candidates looking to work with a supportive team, enjoy a professional work environment, and build a long-term career with opportunities to transition into a hybrid or remote schedule.

Why Join Us?

Competitive pay: $24-$28 per hour based on experience and interview performance

Fast hiring process with onsite interview events

Potential for hybrid or remote work after 6 months

Remote opportunities may be considered after training for highly qualified candidates

Fully stocked breakroom with complimentary snacks and beverages

Business casual environment

Schedule

• Monday-Friday
• 9:00 AM - 5:00 PM

Training

• Week 1: Classroom training
• Week 2: Job shadowing and hands-on learning

Key Responsibilities

• Process prior authorization requests accurately and efficiently.
• Review payer requirements, step therapy guidelines, and authorization criteria.
• Manage insurance denials and appeals while adhering to payer-specific protocols.
• Verify insurance benefits and determine in-network and out-of-network coverage.
• Evaluate medical and pharmacy benefits to determine patient eligibility for treatment.
• Analyze insurance policies and gather supporting documentation from providers when needed.
• Communicate professionally with healthcare providers, patients, payers, and internal teams.
• Maintain timely and accurate documentation within Salesforce and other systems.
• Ensure compliance with payer regulations and internal quality standards.

Ideal Candidate Qualifications

• Insurance Verification or Benefits Investigation experience
• Appeals and Denials experience preferred
• Healthcare, specialty pharmacy, medical office, or insurance background
• Strong attention to detail and documentation skills
• Ability to review and interpret insurance policies
• Experience navigating multiple payer systems
• Excellent communication and customer service skills
• Salesforce experience is a plus

Positions are expected to fill quickly, and selected candidates can start as soon as possible.