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Director Insurance Prior Authorization Jobs in Decatur, GA

Elevance Health

Pharmacy Tech II-Bilingual

Atlanta, GA · On-site

$16.75 - $20.50/hr

Processes prior authorization requests from physician's offices and ensures compliance with ... insurance, wellness programs and financial education resources, to name a few. Elevance Health ...

Elevance Health

Pharmacy Tech II-Bilingual

Atlanta, GA · On-site

$16.75 - $20.50/hr

Processes prior authorization requests from physician's offices and ensures compliance with ... insurance, wellness programs and financial education resources, to name a few. Elevance Health ...

Georgia Urology

PATIENT COORDINATOR

Smyrna, GA · On-site

$16.50 - $22.25/hr

... prior to patient visit as directed. * Forward medical records to requesting physicians. * Schedule patient appointments. * Verify patient insurance information, prior authorization, and collect ...

Georgia Urology PA

PATIENT COORDINATOR

Roswell, GA · On-site

$16 - $21.50/hr

... prior to patient visit as directed. * Forward medical records to requesting physicians. * Schedule patient appointments. * Verify patient insurance information, prior authorization, and collect ...

AKUDO HEALTHCARE

PHARMACY BILLING SPECIALIST

Austell, GA · Remote

$17 - $20/hr

Communicate with insurance companies, prescribers, and facilities to resolve issues * Track and follow up on outstanding claims to ensure reimbursement Prior Authorizations & Documentation * Initiate ...

Georgia Urology

PATIENT COORDINATOR

Roswell, GA · On-site

$16 - $21.50/hr

... prior to patient visit as directed. * Forward medical records to requesting physicians. * Schedule patient appointments. * Verify patient insurance information, prior authorization, and collect ...

Georgia Urology PA

PATIENT COORDINATOR

Smyrna, GA · On-site

$16.50 - $22.25/hr

... prior to patient visit as directed. * Forward medical records to requesting physicians. * Schedule patient appointments. * Verify patient insurance information, prior authorization, and collect ...

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Director Insurance Prior Authorization information

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 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 popular job titles related to Director Insurance Prior Authorization jobs in Decatur, GA? For Director Insurance Prior Authorization jobs in Decatur, GA, the most frequently searched job titles are:
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:
What cities near Decatur, GA are hiring for Director Insurance Prior Authorization jobs? Cities near Decatur, GA with the most Director Insurance Prior Authorization job openings:
Director Insurance Prior Authorization jobs near you

Patient Access Liaison - Rare Disease - East

Amgen

Atlanta, GA

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 4 days ago

Job description

Career CategoryCorporate ServicesJob Description

Join Amgen's Mission of Serving Patients

At Amgen, if you feel likeyou'repart of something bigger,it'sbecause you are. Our shared mission-to serve patients living with serious illnesses-drives all that we do.

Since 1980,we'vehelped pioneer the world of biotech in our fight against the world's toughest diseases. With our focus on four therapeutic areas - Oncology, Inflammation, General Medicine, and Rare Disease - we reachthousandsof patients each year. As a member of the Amgen team,you'llhelp make a lasting impact on the lives of patients as we research, manufacture, and deliver innovative medicines to help people live longer, fuller, happier lives.

Our award-winning culture is collaborative, innovative, andscience-based. If you have a passion for solving complex challenges and driving meaningful impact for patients,you'llthrive as part of the Amgen team.

HOW MIGHT YOU DEFY IMAGINATION?

At Amgen, our shared mission-to serve patients-drives all that we do. As a global biotechnology leader, we collaborate across disciplines to deliver innovative therapies that reach millions of patients worldwide.It'stime for a career you can be proud of.

Live

What youwill do

Let'sdo this.Let'schange the world.

ThePatient Access Liaison (PAL) is a field-based patient access and reimbursement specialist responsible for supporting patients, caregivers, healthcare providers, and sites of care in navigating insurance coverage and reimbursement pathways for Amgen therapies.

ThePAL serves as a key resource in helping stakeholders understand payer requirements, prior authorization processes, reimbursement considerations, and available patient support resources. The role focuses on ensuringtimelyand sustained access to therapy by addressing reimbursement barriers and providing education to patients and providers on coverage and financialassistanceprograms.

Working within a collaborative field environment, thePALpartners with internalteams including Market Access, Medical Affairs, Advocacy, Marketing, Case Management, and Site of Care teams to supportthe patient journey. The roleoperateswith independence in managing assigned patient cases and contributesfieldinsights that inform broader access strategies.

Key Responsibilities

Patient Access and Reimbursement Support

  • Serve as a resource on patient access and reimbursement for infused and specialty therapies.

  • Assistpatients, caregivers, and healthcare providers in navigating insurance benefits, prior authorization requirements, and reimbursement processes.

  • Support the identification and resolution of access challenges, including coverage questions, prior authorization barriers, and denied claims.

  • Provide educationregardingcoding and billing considerations relevant to therapy access.

Patient and Caregiver Engagement

  • Develop relationships with patients and caregivers through phone, virtual, and in-person engagement.

  • Secure written or electronic patient HIPAA authorization within assigned geography.

  • Assess individual patient needs and provide education and resources that support access to therapy.

  • Educate patients on coverage considerations and the stepsrequiredto obtain prior authorization.

  • Provide informationregardingco-payassistanceprograms, national foundations, and free drug programs whenappropriate.

Provider and Site-of-Care Education

  • Educate physician offices and sites of care on therapy coverage pathways and reimbursement processes.

  • Provide informationregardingcommon prior authorization requirements, coding considerations, and billing practices.

  • Support healthcare providers and infusion centers in navigating reimbursement questions related to patient cases.

Access Issue Resolution

  • Investigate patient access challenges before and after infusion.

  • Support physician offices and sites of care in reviewing denied claims andidentifyingpotential next steps.

  • Escalate complex or systemic reimbursement issues toappropriate internalstakeholders.

Cross-Functional Collaboration

  • Partner with internal stakeholders including Market Access, Medical Affairs, Advocacy, Case Managers, and Site of Care teams to support patient access initiatives.

  • Coordinate with internal and external partners to ensureappropriate resourcesare available to support patient access.

  • Share field insightsregardingpayer policies and reimbursement challenges.

Compliance, Safety, and Operational Excellence

  • Adhereto company policies, compliance guidance, andapplicable tofederal, state, and local regulations.

  • Ensure activities align with HIPAA privacy requirements and internal compliance guidelines.

  • Report adverse events and product complaints through established pharmacovigilance processes.

  • Maintainaccuratedocumentation of activities and interactionsin Amgen's internal system.

Win

What we expect of you

Basic Qualifications- Level 5

Doctorate degree

OR

Master's degree and2years of patient services and/or access and reimbursement experience

OR

Bachelor's degree and4years of patient services and/or access and reimbursement experience

OR

Associate's degree and8yearsof patient services and/or access and reimbursement experience

OR

High school diploma / GED and 10years ofpatient services and/or access and reimbursement experience

Basic Qualifications - Level 6

Doctorate degree and 2 years of patient services, and/or access and reimbursement, experience

OR

Master's degree and 4 years of patient services, and/or access and reimbursement, experience

OR

Bachelor's degree and 6 years of patient services, and/or access and reimbursement, experience

Preferred Qualifications

  • Experience supportingbuy-and-bill or infused pharmaceutical therapies

  • Rare disease or orphan drug experience

  • Clinical background such as nursing or allied health

  • Understanding of reimbursement processes including prior authorization, appeals, and denied claims management

  • Knowledge of HIPAA guidelines and FDA regulatory requirements

  • Familiarity with internal and OIG compliance guidelines

  • Strong analytical and problem-solving skills

  • Excellent written and verbal communication skills

  • Ability to manage complex patient situations and resolve access barriers

  • Experience working in cross-functional field teams

  • Proficiencyin Microsoft Office, CRM,AIand relevant systems

  • Access and reimbursement knowledge

  • Prior authorization processes

  • Healthcare reimbursement systems

  • Coding and billing awareness

  • Patient support program knowledge

  • Compliance and privacy requirements

  • Learning agility

  • Decision quality

  • Stakeholder engagement

  • Ability to respond rapidly to urgent access needs to preventtreatment delays or lapses

  • Ability tooperateeffectively inmatrix field environments

  • Travel up to50%, including occasional overnight and weekend commitments

Thrive

What you can expect of us

As we work to develop treatments that take care of others, we also work to care for our teammates' professional and personal growth and well-being.

The annual base salary range is from $158,394 -$185,578 for Level 5 , $164,276 - $ 222,256 for Level 6. Actual salary will vary based on several factors including, but not limited to, relevant skills, experience, and qualifications.

In addition to the base salary, Amgen offers a Total Rewards Plan comprising health and welfare plans for staff and eligible dependents, financial plans with opportunities to save towards retirement or other goals, work/life balance, and career development opportunities including:

  • Comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts.

  • A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan

  • Stock-based long-term incentives

  • Award-winning time-off plans and bi-annual company-wide shutdowns

  • Flexible work models, including remote work arrangements, where possible

Apply now

for a career that defies imagination

Objects in your future are closer than they appear. Join us.

careers.amgen.com

Application deadline

Amgen's application deadline is August 3, 2026; we will continue accepting applications until we receive a sufficient number or select a candidate for the position.

Amgen is an Equal Opportunity employer and will consider you without regard to your race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

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Salary Range

USD -USD

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