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Director Insurance Prior Authorization Jobs in Virginia

Imh

$19.41 - $28.14/hr

The Pre-Access Authorization Specialist I is responsible for accurately verifying and completing insurance eligibility, securing prior authorization and managing authorization related denials to ...

ARM Consulting

Reimbursement Specialist

Fort Belvoir, VA · On-site

$21.75 - $30/hr

Analyze patient insurance coverage including: * * Commercial insurance * * Medicare Part B ... Prior Authorization Support & Access Navigation * * Review payer-specific prior authorization ...

Riverside Health System Non-Providers

$23.90 - $31.10/hr

Timely process of referrals and submit clinical supporting documentation to insurance carriers, manufacturers, or foundations to expedite prior authorization and/or patient assistance processes.

Riverside

$23.90 - $31.10/hr

Timely process of referrals and submit clinical supporting documentation to insurance carriers, manufacturers, or foundations to expedite prior authorization and/or patient assistance processes.

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Showing results 21-40

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

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 Virginia?

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

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

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

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

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

Director Insurance Prior Authorization jobs near you
Infographic showing various Director Insurance Prior Authorization job openings in Virginia as of August 2026, with employment types broken down into 85% Full Time, 13% Part Time, and 2% Contract. Highlights an 90% In-person, 2% Hybrid, and 8% Remote job distribution.

PDN Home Health Authorization Specialist

COMFORT HOME HEALTH LLC

Falls Church, VA • On-site

$25 - $30/hr

Full-time

Medical, Retirement

Posted 17 days ago

Job description

Benefits:
  • 401(k)
  • Competitive salary
  • Training & development

Job Summary
VitalCare Home Health LLC is seeking an experienced Authorization Specialist to join our growing Home Health team. The Authorization Specialist is responsible for obtaining, tracking, and managing insurance authorizations for skilled nursing and private duty nursing services. This position works closely with physicians, case managers, Medicaid Managed Care Organizations (MCOs), clinical staff, and families to ensure timely authorization approvals and uninterrupted patient care.
Responsibilities
* Submit initial and continued authorization requests.
* Track authorization expiration dates and renewals.
* Verify Medicaid and insurance eligibility.
* Communicate with MCOs regarding authorization status.
* Coordinate with physicians to obtain required documentation.
* Review nursing assessments and physician orders for completeness.
* Monitor pending authorizations and follow up to prevent delays.
* Resolve authorization denials and submit additional documentation when required.
* Maintain accurate documentation in Alora Plus EMR.
* Collaborate with Intake, Clinical Managers, and Scheduling staff.
* Maintain HIPAA compliance and confidentiality.
Preferred Experience
* Home Health or Private Duty Nursing (PDN)
* Virginia Medicaid
* CCC Plus
* DMAS documentation
* Prior Authorization
* Insurance Verification
* Alora Plus EMR (preferred)
Required Qualifications
* Minimum 2 years of Home Health authorization experience.
* Experience with Virginia Medicaid and Managed Care Organizations.
* Strong knowledge of authorization processes.
* Excellent organizational and communication skills.
* Ability to manage multiple authorizations simultaneously.
* Strong computer skills and attention to detail.
Preferred Payers Experience
* Anthem HealthKeepers Plus
* Sentara Health Plans
* Molina Healthcare
* Aetna Better Health of Virginia
* UnitedHealthcare Community Plan
Benefits
* Competitive salary
* 401(k)
* Professional Development Opportunities
Skills
* Prior Authorization
* Home Health
* Medicaid
* Insurance Verification
* Medical Documentation
* EMR
* Alora Plus
* HIPAA
* Microsoft Office
* Customer Service
* Communication
* Time Management
* Attention to Detail
* Problem Solving
Nice-to-Have
* Bilingual (English/Spanish)
* Experience with pediatric skilled nursing
* Experience with ventilator, trach, and G-tube cases
* Experience working with Medicaid waiver programs

Flexible work from home options available.