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Director Insurance Prior Authorization Jobs in Texas

RPC Company

Be Seen First

Prior Authorization Specialist

Farmers Branch, TX · On-site

$22 - $24/hr

We are seeking a detail-oriented Prior Authorization Specialist - Pharmacy Technician to support patients, providers, and insurance partners through the medication prior authorization process. This ...

Ardent Health

Authorization Specialist

Amarillo, TX · On-site

$16.50 - $22/hr

Enters insurance prior authorization documentation into the electronic health record. * Communicates patient financial responsibility for healthcare services to patients and guarantors. * Create and ...

Ardent Health

Authorization Specialist

Harker Heights, TX · On-site

$16.50 - $22/hr

Enters insurance prior authorization documentation into the electronic health record. * Communicates patient financial responsibility for healthcare services to patients and guarantors. * Create and ...

BSA Health System

Authorization Specialist

Amarillo, TX · On-site

$14.75 - $19.50/hr

Enters insurance prior authorization documentation into the electronic health record. * Communicates patient financial responsibility for healthcare services to patients and guarantors. * Create and ...

Medix

Onsite Prior Authorization Specialist

Plano, TX · On-site

$23 - $26/hr

This position is primarily responsible for contacting insurance companies to obtain status updates on submitted prior authorizations, entering approval and denial documentation into the electronic ...

Onco360

Pharmacy Prior Authorization Specialist

Houston, TX · On-site

$19.50 - $25.25/hr

Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...

Onco360

Pharmacy Prior Authorization Specialist

Houston, TX · On-site

$19.50 - $25.25/hr

Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...

Onco360

Pharmacy Prior Authorization Specialist

Houston, TX · On-site +1

$19.50 - $25.25/hr

Company Paid Life Insurance; and Short/Long-Term Disability What You'll Do The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations ...

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All JobsInsurance Prior Authorization JobsDirector Insurance Prior Authorization JobsDirector Insurance Prior Authorization Jobs in Texas

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 the most commonly searched types of Insurance Prior Authorization jobs in Texas?

The most popular types of Insurance Prior Authorization jobs in Texas are:

What are popular job titles related to Director Insurance Prior Authorization jobs in Texas?

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

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

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

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

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

Director Insurance Prior Authorization jobs near you

Customer Service / Prior Authorization Representative

Gryphon Healthcare

Houston, TX • On-site

$15.25 - $20.75/hr

Full-time

Medical

Re-posted 23 hours ago

Job description

Customer Service / Prior Authorization Representative
We are seeking an enthusiastic and detail-oriented Customer Service / Prior Authorization Representative to join our team. In this role, you will serve as the first point of contact for our patients while also managing prior authorization requests to help ensure timely access to care.
The ideal candidate will have prior authorization experience in a medical setting, with Radiology experience strongly preferred. You will work closely with our client medical offices, insurance carriers, and internal teams to obtain authorizations, verify benefits, resolve patient inquiries, and support the Medical Records Department.
The Ideal Candidate Will Have:
  • Previous prior authorization experience is required – Minimal 1 year experience required
  • Radiology prior authorization experience is strongly preferred
  • Experience with medical insurance verification
  • Knowledge of commercial insurance plans, Medicare, and Medicaid
  • Ability to interpret Explanation of Benefits (EOBs)
  • Strong attention to detail and accurate data entry skills
  • Excellent communication and customer service skills
  • Previous call center or high-volume patient service experience
  • A passion for helping patients and providing exceptional customer service
If you thrive in a fast-paced healthcare environment and enjoy helping patients while ensuring timely authorization of medical services, we encourage you to apply!
Job Description – Customer Service / Prior Authorization Representative
Location: Houston, TX 77041
Job Summary
The Customer Service / Prior Authorization Representative is responsible for responding to patient account inquiries, obtaining and managing insurance prior authorizations, verifying insurance eligibility and benefits, processing patient payments, generating patient statements, and assisting with medical records requests. This position works closely with providers, insurance companies, and patients to ensure services are authorized and patient billing questions are resolved accurately and efficiently.
Duties and Responsibilities
  • Answer incoming calls from patients and customers, identifying the type of assistance needed.
  • Obtain, submit, monitor, and document insurance prior authorizations for medical services and procedures.
  • Verify insurance eligibility, benefits, authorization requirements, and referral requirements.
  • Follow up with insurance carriers regarding pending or denied authorizations and appeals as appropriate.
  • Coordinate with physician offices, scheduling staff, and clinical personnel to obtain required documentation for authorization requests.
  • Ask appropriate questions and actively listen to identify customer concerns while accurately documenting information in company systems.
  • Research patient accounts and healthcare claims using multiple computer systems.
  • Ensure appropriate insurance benefits are applied to each patient account.
  • Resolve patient billing questions using clear, professional communication.
  • Process patient payments and generate patient statements.
  • Assist the Medical Records Department by retrieving records for patients, attorneys, and third-party vendors.
  • Meet established performance goals for quality, productivity, customer satisfaction, accuracy, and attendance.
  • Demonstrate excellence in customer service with every patient interaction.
  • Participate in continuing education to remain current on medical billing, insurance regulations, and prior authorization requirements.
  • Support other members of the Revenue Cycle team as needed.
  • Perform other duties as assigned.
Competencies
  • Customer Service
  • Problem Solving
  • Analytical Thinking
  • Attention to Detail
  • Technical Skills
  • Oral Communication
  • Written Communication
  • Teamwork
  • Organization and Time Management
  • Ethics and Confidentiality
  • Adaptability
Education Requirements
  • High School Diploma or equivalent required.
Experience Requirements
  • Minimum of one (1) year of customer service experience in a medical office, clinic, hospital, emergency room, or healthcare setting.
  • Minimum of one (1) year of prior authorization experience required.
  • Radiology prior authorization experience strongly preferred.
  • Medical billing and insurance verification experience preferred.
Special Knowledge, Skills, and Abilities Required
  • Knowledge of insurance prior authorization processes and payer requirements.
  • Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans.
  • Knowledge of medical billing and collection practices.
  • Ability to interpret Explanation of Benefits (EOBs).
  • Familiarity with EMR/EHR systems, EDI, and insurance portals.
  • Understanding of HIPAA regulations and patient confidentiality requirements.
  • Strong organizational, follow-up, and time management skills.
  • Excellent verbal and written communication skills.
  • Ability to multitask and prioritize in a fast-paced environment.
  • Detail-oriented with accurate data entry skills.
  • Proficiency with Microsoft Outlook and Windows-based computer systems.
  • Bilingual (English/Spanish) is a plus but not required.
Working Environment
Ability to work in a fast-paced, high-volume healthcare environment. Must be able to manage multiple priorities while maintaining accuracy and excellent customer service. Flexibility to work additional hours as needed to meet business demands.

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