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Director Insurance Prior Authorization Jobs in Decatur, GA

PainPoint

Prior Authorization Coordinator

Atlanta, GA · On-site +1

$19 - $21/hr

Prior Authorization Coordinator Full-Time | $19-21/hour | Monday-Friday | 8:00 AM-4:30 PM CST ... Communicate with practices, vendors, insurance companies, patients, and management to secure ...

PruittHealth

Authorization Specialist

Norcross, GA · On-site

$16.50 - $22/hr

... 2. Secures prior authorization from insurance companies and documents approval details ... Reports as directed when called in during a disaster or other emergency situation as directed by ...

PruittHealth

Authorization Specialist

Norcross, GA

$17 - $22.50/hr

... 2. Secures prior authorization from insurance companies and documents approval details ... directed when called in during a disaster or other emergency situation as directed by agency ...

PruittHealth

Authorization Specialist

Norcross, GA · On-site

$17 - $22.50/hr

Secures prior authorization from insurance companies and documents approval details appropriately ... directed when called in during a disaster or other emergency situation as directed by agency ...

Aveanna Healthcare

HHH - Authorization Specialist

Atlanta, GA · On-site

$17 - $22.75/hr

Assessing if a patient meets the criteria for covered home healthcare services based on their medical diagnosis and insurance policy. * Prior authorization requests: Initiating prior authorization ...

TTI

Customer Service Rep II - Non-Exempt

Atlanta, GA

$15.50 - $21/hr

Representative will ensure patient insurance coverage and benefits, identify requirements for prior approval and submit for authorization. Assists with appealing prior authorization denials, retro ...

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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.
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What job categories do people searching Director Insurance Prior Authorization jobs in Decatur, GA look for? The top searched job categories for Director Insurance Prior Authorization jobs in Decatur, GA are:
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Director Insurance Prior Authorization jobs near you
Prior Authorization Coordinator

Prior Authorization Coordinator

Soleo Health Inc

Atlanta, GA • On-site, Remote

$20 - $23/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 9 days ago

Job description

Description

Soleo Health is seeking a Prior Authorization Coordinator to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care!


Specialty infusion prior authorization experience required. Hours are Monday-Friday 9:00am - 5:30pm Eastern Standard time.


Soleo Health Perks:

  • Competitive Wages
  • 401(k) with a Match
  • Referral Bonus
  • Paid Time Off
  • Great Company Culture
  • Annual Merit Based Increases
  • No Weekends or Holidays
  • Paid Parental Leave Options
  • Affordable Medical, Dental, & Vision Insurance Plans
  • Company Paid Disability & Basic Life Insurance
  • HSA & FSA (including dependent care) Options
  • Education Assistance Program


The Position:

The Prior Authorization Coordinator ensures seamless patient care by maintaining prior authorizations, copay assistance, and verifying existing insurance coverage for ongoing services. Responsibilities include:

  • Must have a solid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits
  • Verify insurance benefit information monthly via multiple methods such as online tools, calling payors or processing test claims
  • Generates a prior authorization expiration report weekly, bi-weekly, or monthly
  • Review clinical documents for prior authorization/pre-determination submission purposes
  • Secures prior authorization, pre-determination, or medical review
  • Contact prescriber's office to obtain information that is required to complete ongoing re-authorization and verification of benefits
  • Places outbound calls to patients or prescriber's offices to notify of any delays due to more information needed to process or due to a prior authorization
  • Document insurance coverage of medications, administration supplies, and related infusion services including prior authorization requirements and coordination of benefits
  • Provides exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner
  • Ensures the appropriate notification of patients in regards to their financial responsibility, benefit coverage, and payor authorization for services to be provided
  • Generates patient forms
  • Maintains up to date prior authorization report


Schedule:

  • Monday-Friday 9:00am-5:30pm Eastern Standard Time

Requirements

  • High school diploma or equivalent required.
  • At least 2 years of healthcare intake/admissions and/or reimbursement experience
  • Previous medical and pharmacy benefit experience is required
  • Initiating and securing prior authorizations, pre-determination, and appeals
  • Ability to interpret payor contract fee schedules based on NDC and HCPCS units
  • Ability to effectively handle multiple priorities within a changing environment
  • Basic level skill in Microsoft Excel
  • Basic level skill in Microsoft Word


About Us: Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference!


Soleo's Core Values:

  • Improve patients' lives every day
  • Be passionate in everything you do
  • Encourage unlimited ideas and creative thinking
  • Make decisions as if you own the company
  • Do the right thing
  • Have fun!


Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture.


Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.


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