ZipRecruiter

Log In

1

Director Insurance Prior Authorization Jobs in Wisconsin

SSM Health

Rehabilitation Services Aide

Madison, WI · On-site

$15.50 - $21.25/hr

Under direct supervision of a physical or occupational therapist, assists in providing patient care, including assistance with insurance prior authorization. Takes responsibility for equipment ...

SSM Health

Rehabilitation Services Aide

Madison, WI · On-site

Under direct supervision of a physical or occupational therapist, assists in providing patient care, including assistance with insurance prior authorization. Takes responsibility for equipment ...

Southwest Health

Referral Advocate

Platteville, WI · On-site

$17.25 - $22.50/hr

Additional duties may be assigned by the Director of Clinic Operations. Essential Job Functions and ... Assists Patient Financial Services department to insure prior authorization requirements are met ...

Novir

Insurance Verification Representative

Milwaukee, WI · On-site

$16.75 - $21.50/hr

Be direct and open. Speak with honesty and courage, and respect others for doing the same. Say what ... prior authorization tasks. This role is critical in creating a smooth patient experience and ...

Novir

Insurance Verification Representative

Milwaukee, WI

$16.75 - $21.50/hr

Be direct and open. Speak with honesty and courage, and respect others for doing the same. Say what ... prior authorization tasks. This role is critical in creating a smooth patient experience and ...

next page

Showing results 1-20

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

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.
What are the most commonly searched types of Insurance Prior Authorization jobs in Wisconsin? The most popular types of Insurance Prior Authorization jobs in Wisconsin are:
What are popular job titles related to Director Insurance Prior Authorization jobs in Wisconsin? For Director Insurance Prior Authorization jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Director Insurance Prior Authorization jobs in Wisconsin look for? The top searched job categories for Director Insurance Prior Authorization jobs in Wisconsin are:
What cities in Wisconsin are hiring for Director Insurance Prior Authorization jobs? Cities in Wisconsin 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 Wisconsin as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Prior Authorization/Referral Specialist

Froedtert South, Inc.

Pleasant Prairie, WI • On-site, Remote

$17 - $25.25/hr

Part-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 21 days ago

Froedtert South rating

6.9

Company rating: 6.9 out of 10

Based on 39 frontline employees who took The Breakroom Quiz

453rd of 887 rated healthcare providers

Job description

  • POSITION PURPOSE
    • The Prior-Authorization/Referral Specialist plays a key role in supporting patient access to care by verifying insurance eligibility and benefits, and securing required pre-certifications, authorizations, and referrals for both facility and professional services. This position ensures timely and accurate communication with payors and healthcare providers, obtains necessary clinical documentation to support medical necessity, and maintains detailed records throughout the authorization process.
  • MINIMUM EDUCATION REQUIRED
    • High School or GED
  • MINIMUM EXPERIENCE REQUIRED
    • One (1) year of insurance/prior authorization experience (preferred)
    • Experience and familiarity with using insurance portals
  • LICENSES / CERTIFICATIONS REQUIRED
    • None
  • KNOWLEDGE, SKILLS & ABILITIES REQUIRED
    • Strong customer service orientation with excellent interpersonal and computer skills.
    • Working knowledge of medical terminology and healthcare documentation standards.
    • Demonstrated ability to manage time effectively, prioritize tasks, and maintain accuracy in a high-volume environment.
    • Proficient with internet-based tools, email communication, and Microsoft Office applications (e.g., Word, Excel, Outlook).
    • Strong written and verbal communication skills, with the ability to interact professionally with patients, clinicians, and insurance representatives.
    • Proven experience in prior authorizations, referrals, patient registration, insurance verification, and understanding of various health insurance plans (preferred).
    • Proficient in navigating online prior authorization portals and working with multiple commercial and government payors (preferred).
    • Knowledge of medical coding systems, including ICD-10, CPT, and HCPCS codes (preferred).
  • PRINCIPLE ACCOUNTABILITIES AND ESSENTIAL DUTIES
    • Verify insurance eligibility and benefits for scheduled services to determine prior-authorization or referral requirements.
    • Initiate and follow through on prior-authorization and referral requests with payors, ensuring timely approvals.
    • Collect and submit required clinical documentation to support medical necessity and facilitate authorization.
    • Document all authorization activities accurately in the electronic health record (EHR) and/or designated tracking systems.
    • Communicate authorization status and requirements clearly to providers, clinical staff, and patients as needed.
    • Coordinate with providers and clinical teams to obtain additional information or clarification required by payors.
    • Maintain up-to-date knowledge of payer policies, coding guidelines (ICD-10, CPT, HCPCS), and authorization processes.
    • Ensure timely resolution of authorization-related issues to prevent delays or denials in patient care or billing.
    • Provide exceptional customer service when interacting with internal teams, external payors, and patients.
    • Participate in continuous quality improvement efforts, including audits, training, and performance reviews.
       
      Salary Range: $17.00 to $25.25/hr (based on experience)
       

      Benefits:

      • Medical, dental and vision benefits available
      • 403(b) company match available
      • Tuition reimbursement
      • Employee discount program
      • Competitive PTO

What Froedtert South employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply