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Director Insurance Prior Authorization Jobs in Texas

W3R

PRIOR AUTHORIZATION THERAPIST

Austin, TX

There will not be direct patient care involved. * Therapists will be working with electronic ... Prior Authorization experience. * 1 year of customer service or call-center experience, preferred.

Medix

Prior Authorization Pharmacy Technician

Plano, TX · On-site

$23 - $26/hr

Prior Authorization Submission & Processing: Prepare and submit prior authorization requests ... Interpret and work insurance reject codes, payer edits, and claim rejections to identify root ...

W3R

Prior Authorization Therapist

Austin, TX · On-site

There will not be direct patient care involved. Therapists will be working with electronic patient ... Prior Authorization experience. 1 year of customer service or call-center experience, preferred.

W3R

Prior Authorization Therapist

Austin, TX · On-site

Consults with clinical reviewers and/or medical directors regarding members diagnosis, strengths ... Prior Authorization experience. * 1 year of customer service or call-center experience, preferred.

Mays Plus Inc

Insurance Authorization Specialist

Paris, TX · On-site

$13.75 - $18.25/hr

Obtain prior authorizations and re-authorizations from private insurance, Medicare Advantage, and ... Direct impact on ensuring patients receive timely care * Work across both home health and hospice ...

W3R

RN Prior Authorization

Austin, TX · On-site

No direct patient care * 8 hour shifts unless OT is needed and approved * will have a shift between 7am and 7pm, so must be available for all shifts between that time. * The Registered Nurse conducts ...

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Healthcare Authorization Specialist

Houston, TX · On-site

$19/hr

High school diploma or GED required. * 1-2 years of prior authorization experience required. * Experience with provider outreach. * Experience with healthcare insurance verification. * Knowledge of ...

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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 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

Prior Authorization Specialist - Weekend Only

Select Medical

Temple, TX

$14.50 - $19.25/hr

Part-time

Life, Retirement

Re-posted yesterday

Job description

Baylor Scott & White Institute for Rehabilitation

*A joint venture with Select Medical & Baylor Scott & White*

Prior Authorization Specialist  - Part-Time Weekends

This position will work every Saturday and Sunday, 8 hours each day

This is primarily a work-from-home position, but to be considered, candidates must live within driving distance of Austin, TX, Temple, TX, or the DFW area.

 


Job Responsibilities

Using discretion and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute Inpatient Rehabilitation Hospital.

  1. Follows the Select Workflow Process for initiating and completing patient authorizations. Takes full responsibility for following the “Workflow Process” and ensures each referral follows the process, from taking the initial referral until final disposition, acceptance or denial. As appropriate, submits the preadmission assessments completed by clinical liaisons to the insurance company.
  2. Ensures documentation meets standards and expectations by working and mentoring team as needed.
    Obtains timely authorization of all patients requiring pre-certification and is accountable for conversion percentage and results.
  3. Ensures all policies governing commercial pre-certification and authorization are followed to minimize financial risk.
    Develops relationships that increase and stabilize conversion as well as generates referrals both locally and regionally. This may include identifying relationship opportunities for self and others within Select Medical to include but not limited to CEO, DBD, CLs, Admissions Coordinator and Case Management team that may help grow relationships and impact results.
  4. Maintains profiles on each payer to include case managers and medical directors, P2P and appeal info.
  5. Identifies by payor communication preference and utilizes to maximize results.
  6. Encourages and models teamwork, communication and collaboration with other departments to include but not limited to the transition of patients into the critical illness recovery hospital or acute inpatient rehabilitation hospital.
  7. Serves as a resource to the Business Development Team educating them on payor preference to promote exceptional customer service and efficient processes
  8. Maintains and further develops relationships with customers which may include but are not limited to surveying for satisfaction with the work of Select Medical and off-site meetings with the customer.
  9. Evaluates Non-Medicare benefits as verified by the Central Business Office or Rehab Admissions Coordinator. Reviews benefits with Admissions Coordinator for possible risk and applies/completes written guidelines as necessary to reduce or manage risk.
  10. Answers phone with appropriate behavior and ensures back-up when not available or out of the office.
  11. Works closely with Admissions Coordinator to apply correct accommodation code per contract as well as billing/reimbursement requirements.
  12. Tracks approval and denials through TOC.
  13. Ensure outstanding customer service for all customers.
  14. Performs other duties as requested.

Minimum Qualifications

  • 2 years of direct experience in third-party reimbursement 

Preferred Experience

  • Previous Experience within a physical rehabilitation setting preferred
  • Experience working with Excel and databases
  • Licensure as a Registered Nurse or LVN/LPN 

Why Join Us:

  • Start Strong: Extensive orientation program to ensure a smooth transition into our setting.
  • Opportunity for Advancement: Demonstrate your skills and dedication, which could lead to potential full-time opportunities
  • Foster Well-being: We offer benefits that support the financial, work/life, and emotional well-being of you and your family members.  Part time/Per Diem positions are eligible for 401k based on reaching 1,000 hours within their first anniversary or subsequent calendar year. We also offer our employee assistance program to part-time employees.
  • Your Impact Matters: Join a team of over 44,000 committed to providing exceptional patient care

Equal Opportunity Employer, including Disabled/Veterans

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