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Director Insurance Prior Authorization Jobs in Georgia

Addison Group

Precertification Specialist

Smyrna, GA · On-site

$22/hr

Obtain, track, and manage prior authorizations for scheduled diagnostic testing and physician services. * Verify patient insurance eligibility, benefits, coverage, and authorization requirements ...

Addison Group

Precertification Specialist

Smyrna, GA · On-site

$22/hr

Obtain, track, and manage prior authorizations for scheduled diagnostic testing and physician services. * Verify patient insurance eligibility, benefits, coverage, and authorization requirements ...

A Plus Optique

Be Seen First

Front Desk Receptionist/ Patient Coordinator

Fayetteville, GA · On-site

$10 - $14/hr

Call patients prior to appointments to communicate any issues (insurance not being active, no ... authorizations are received prior to the appointment and are entered in the patient's chart for ...

A Plus Optique

Be Seen First

Front Desk Receptionist/ Patient Coordinator

Fayetteville, GA · On-site

$10 - $14/hr

Call patients prior to appointments to communicate any issues (insurance not being active, no ... authorizations are received prior to the appointment and are entered in the patient's chart for ...

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Director Insurance Prior Authorization information

What does a director 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 are the key skills and qualifications needed to thrive as a director insurance prior authorization?

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 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.

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 popular job titles related to Director Insurance Prior Authorization jobs in Georgia?

For Director Insurance Prior Authorization jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Director Insurance Prior Authorization jobs in Georgia look for?

The top searched job categories for Director Insurance Prior Authorization jobs in Georgia are:

What cities in Georgia are hiring for Director Insurance Prior Authorization jobs?

Cities in Georgia with the most Director Insurance Prior Authorization job openings:

Director Insurance Prior Authorization jobs near you

Precertification Specialist

Addison Group

Smyrna, GA • On-site

$22/hr

Contractor

Medical, Dental, Vision, Retirement

Re-posted 7 days ago

Job description

Precertification Specialist

Location: Smyrna, GA

Compensation: $22.00 per hour

Employment Type: Contract-to-Hire fully onsite

Schedule: Monday-Friday, 8:00 AM-5:00 PM

Benefits: This position is eligible for medical, dental, vision, and 401(k) benefits.

About the Opportunity

Addison Group is partnering with a well-established gastroenterology and hepatology practice to identify an experienced Precertification Specialist for a contract-to-hire opportunity within its Revenue Cycle department.

This position will support a growing precertification team responsible for verifying insurance coverage, obtaining prior authorizations, and ensuring scheduled diagnostic services are financially cleared before the patient's appointment. The department is currently rebuilding its workflows and expanding its team, making this an excellent opportunity for someone who is dependable, analytical, teachable, and interested in joining a collaborative healthcare environment.

Key Responsibilities

  • Obtain, track, and manage prior authorizations for scheduled diagnostic testing and physician services.
  • Verify patient insurance eligibility, benefits, coverage, and authorization requirements before services are rendered.
  • Work with commercial and government insurance payers, including Blue Cross Blue Shield and UnitedHealthcare.
  • Review scheduled services and identify authorization, eligibility, or coverage issues that could delay patient care or reimbursement.
  • Calculate and communicate patient financial responsibility estimates when applicable.
  • Perform pre-service collection activities and help secure patient payments before scheduled services.
  • Document all authorization, eligibility, and account activity accurately within Epic.
  • Utilize payer portals, clearinghouses, spreadsheets, and other systems to research and complete precertification requests.
  • Collaborate with scheduling, clinical, billing, and financial teams to ensure patients are cleared for service.
  • Follow up with insurance carriers regarding pending or denied authorization requests.
  • Maintain productivity expectations of approximately 40-50 completed prior authorizations per day.
  • Meet established quality, accuracy, attendance, and performance standards.
  • Ensure compliance with organizational policies, payer guidelines, and regulatory requirements.

Qualifications

  • High school diploma or GED required.
  • Minimum of two years of experience in precertification, prior authorization, revenue cycle, insurance verification, or healthcare collections.
  • Physician or professional-fee billing experience required.
  • Previous experience obtaining prior authorizations for diagnostic testing or specialty physician services.
  • Proficiency with Epic is required.
  • Experience with Waystar or another healthcare clearinghouse is preferred.
  • Strong knowledge of commercial insurance eligibility, benefits, and authorization requirements.
  • Ability to work from spreadsheets, payer portals, and multiple healthcare systems.
  • Excellent communication, customer service, and organizational skills.
  • Ability to manage a high-volume workload while maintaining accuracy.
  • Strong attendance, punctuality, and dependability are required.

Preferred Background

We are seeking candidates who are:

  • Analytical thinkers who can research and resolve complex authorization issues.
  • Good listeners who seek to understand instructions before responding.
  • Open to peer-to-peer training, coaching, and workflow changes.
  • Comfortable working within an innovative and diverse team.
  • Professional, dependable, and able to adapt as the department continues to grow.
  • Experienced within physician practices, specialty healthcare, gastroenterology, or another professional-fee environment.

About the Organization

The organization is one of the Southeast's oldest and largest medical practices specializing in adult gastroenterology and hepatology. It provides specialty care across several locations throughout the metropolitan Atlanta area and surrounding communities.

The Revenue Cycle department is currently being rebuilt and retrained, with workflows being redesigned to improve productivity and operational efficiency. The current department includes approximately 35 employees and is expected to grow to 45-50 team members.