ZipRecruiter

Log In

1

Director Insurance Prior Authorization Jobs (NOW HIRING)

DMOS

Prior Authorization Specialist - MRI

West Des Moines, IA · On-site

$16.50 - $22/hr

A rare opportunity to assist with obtaining insurance approval for patient MRI scans is available ... As a Prior Authorization Specialist with our MRI department you will submit prior authorization via ...

DMOS

Prior Authorization Specialist - MRI

West Des Moines, IA · On-site

$16.50 - $22/hr

A rare opportunity to assist with obtaining insurance approval for patient MRI scans is available ... As a Prior Authorization Specialist with our MRI department you will submit prior authorization via ...

next page

Showing results 1-20

All JobsInsurance Prior Authorization JobsDirector Insurance Prior Authorization Jobs

Director Insurance Prior Authorization information

What does a Director of Insurance Prior Authorization do?

A Director of Insurance Prior Authorization oversees the processes required to obtain insurance approvals for medical procedures, prescriptions, or treatments. They manage teams responsible for submitting prior authorization requests and ensure compliance with insurance guidelines and regulations. Their role includes improving workflow efficiency, reducing denials, and collaborating with healthcare providers and insurance companies. Additionally, they analyze trends to optimize the authorization process and provide training to staff on policy changes.

What is the difference between Director Insurance Prior Authorization vs Insurance Authorization Specialist?

AspectDirector Insurance Prior AuthorizationInsurance Authorization Specialist
CredentialsBachelor's degree, industry certifications often preferredHigh school diploma or equivalent, relevant certifications beneficial
Work EnvironmentManagement level, overseeing teams and processesOperational role, performing authorization tasks
Employer & Industry UsageHospitals, insurance companies, healthcare organizationsMedical offices, insurance companies, healthcare providers
Primary ResponsibilitiesOverseeing authorization processes, policy compliance, team managementProcessing authorization requests, verifying coverage, documentation

The main difference is that the Director Insurance Prior Authorization manages teams and oversees authorization policies, while the Insurance Authorization Specialist handles the day-to-day processing of authorization requests. Both roles require knowledge of insurance policies, but the director position involves leadership and strategic oversight.

What are the key skills and qualifications needed to thrive as a Director of Insurance Prior Authorization, and why are they important?

To thrive as a Director of Insurance Prior Authorization, you need expertise in healthcare administration, insurance processes, and regulatory compliance, typically supported by a bachelor's or master's degree in healthcare or business administration. Familiarity with prior authorization software, electronic health records (EHRs), and payer systems is crucial for overseeing efficient authorization workflows. Strong leadership, problem-solving, and communication skills help drive team performance and manage complex stakeholder relationships. These skills ensure timely approvals, reduce claim denials, and maintain regulatory compliance, which directly impact patient access and organizational revenue.

What are some common challenges faced by a Director of Insurance Prior Authorization, and how can they be effectively managed?

A Director of Insurance Prior Authorization often encounters challenges such as navigating constantly changing insurance requirements, ensuring timely approvals for patient care, and managing high volumes of authorization requests. Effective management involves staying updated on payer policies, implementing robust tracking systems, and fostering strong communication between clinical, administrative, and payer teams. Building a knowledgeable team and utilizing technology to streamline workflows can also help reduce denials and improve turnaround times.
More about Director Insurance Prior Authorization jobs
What cities are hiring for Director Insurance Prior Authorization jobs? Cities with the most Director Insurance Prior Authorization job openings:
What are the most commonly searched types of Insurance Prior Authorization jobs? The most popular types of Insurance Prior Authorization jobs are:
What states have the most Director Insurance Prior Authorization jobs? States with the most job openings for Director Insurance Prior Authorization jobs include:
What job categories do people searching Director Insurance Prior Authorization jobs look for? The top searched job categories for Director Insurance Prior Authorization jobs are:
Director Insurance Prior Authorization jobs near you
Infographic showing various Director Insurance Prior Authorization job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 88% Full Time, 10% Part Time, and 1% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.
Insurance Prior Authorizations Specialist

Insurance Prior Authorizations Specialist

Sound Retina PS

Tacoma, WA • On-site

$23 - $32.94/hr

Full-time

Posted 14 days ago

Job description

Description:

Job Description

Job Title: Prior Authorizations Specialist

Reports To: Financial Services Manager

FLSA Status: Non-Exempt

Job Summary: The Prior Authorizations Specialist is responsible for obtaining and managing insurance prior authorizations to ensure timely patient access to medically necessary retina services. This role works closely with providers, clinical staff, patients, and insurance carriers to verify coverage, secure authorizations, and maintain accurate documentation while ensuring compliance with payer requirements and regulatory guidelines. The ideal candidate is detail-oriented, proactive, and solutions-focused, with strong organizational skills and the ability to prioritize multiple requests in a fast-paced healthcare environment. Success in this role requires excellent communication, a commitment to quality and productivity, and the ability to work collaboratively to support exceptional patient care and positive financial outcomes for the practice.

Major Responsibilities

Position: Insurance Prior Authorizations Specialist

Department: Financial Services

Reports to: Financial Services Manager

Job Type: Full-Time, On-Site. Non-Exempt, Monday - Friday.

Responsibilities:

  • Review and monitor patient schedules in a timely manner as assigned by department lead, identifying patient procedures/treatments that require prior authorization.
  • Enters, verifies and updates demographic, insurance and pre-authorization information to ensure proper claims adjudication.
  • Answer patient and clinical staff questions regarding insurance coverage and pre-authorizations.
  • Follows all internal processes and procedures; follows all regulations and guidelines set by Medicare, state programs and PPO/HMO plans.
  • Determine when documentation does not meet medical policy guidelines and coordinate appropriate follow up by clinical staff members that aid in the prior authorization process.
  • Prioritizes incoming authorization requests according to urgency and necessity.
  • Understands prior authorization(s) that are necessary for any services that are rendered to patients at Sound Retina.
  • Initiates the steps necessary to obtain prior authorizations from insurance companies and performs appropriate follow up to meet all deadlines and prevent prior authorization denials.
  • Clearly document in practice management system all communications and contacts with payers, providers and personnel in standardized documentation requirements, including proper format.
  • Maintain detailed filing and archiving of prior authorizations to support post-claim denial workflows.
  • Stays informed, updated and researches information regarding insurance criteria for prior authorizations.
  • Update and maintain prior authorization tools.
  • Growing knowledge of HCPCs, CPT procedure codes and ICD-10 diagnosis updates.
  • Maintain daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership.
  • Ability to maintain patient confidentiality and present themselves in a professional manner.
  • Ensures compliance with State and Federal Laws & Regulations for Managed Care and other Third-Party Payors.
  • Provides general assistance when needed to patients, vendors, co-workers, etc.
  • Performs other duties as directed by the Billing Department Lead.

QUALIFICATIONS

  • High School Graduate or GED equivalent required.
  • 1+ year experience in insurance authorizations and coordination; ophthalmology and retina preferred.
  • 2-3 years previous experience in pre-auth verification; experience with obtaining authorizations, referral coordination and patient services.
  • 2-3 years previous experience with insurance eligibility.
  • Prior experience working Medicare, Medicaid, other government payers and commercial insurance.
  • Effective written and verbal communication skills.
  • Ability to multi-task, prioritize needs to meet required timelines.
  • Customer service experience required.
  • Able to demonstrate independent judgment and initiative appropriately

Job Type: Full-time

Requirements: