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Director Insurance Prior Authorization Jobs (NOW HIRING)

Logan Health

Prior Authorization Specialist

$18.50 - $24.50/hr

Submit CPT and HCPCS codes and medical records to insurers to expedite authorizations. * Verify ... Possess insight and understanding into reimbursement and claims procedures and its direct impact on ...

Grace Health

Prior Authorization Specialist

Battle Creek, MI · On-site

$17 - $22.75/hr

Medical, vision, dental, life, and disability insurance * 401K match * 8 paid holidays * Employee ... Educates patients and staff about the process of medication prior authorizations. * Processes ...

Grace Health

Prior Authorization Specialist

Battle Creek, MI · On-site

$16.25 - $21.50/hr

Medical, vision, dental, life, and disability insurance * 401K match * 8 paid holidays * Employee ... Educates patients and staff about the process of medication prior authorizations. * Processes ...

Grace Health

Prior Authorization Specialist

Battle Creek, MI · On-site

$17 - $22.75/hr

Medical, vision, dental, life, and disability insurance * 401K match * 8 paid holidays * Employee ... Educates patients and staff about the process of medication prior authorizations. * Processes ...

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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.

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Director Insurance Prior Authorization jobs near you
Infographic showing various Director Insurance Prior Authorization job openings in the United States as of August 2026, with employment types broken down into 88% Full Time, 10% Part Time, and 2% Contract. Highlights an 87% In-person, 3% Hybrid, and 10% Remote job distribution.

Prior Authorization Specialist

Cornerstone Family Healthcare

Middletown, NY • On-site

$21/hr

Other

Medical, Retirement, PTO

Re-posted 8 days ago

Job description

Prior Authorization Specialist

Cornerstone Family Healthcare is actively recruiting for a Prior Authorization Specialist to join our growing team in Middletown, NY.

RATE OF PAY/SALARY: $21.00 per hour

WORK LOCATION(S): Middletown, NY

STATUS: Full-time

CORNERSTONE'S MISSION:

Cornerstone Family Healthcare is a non-profit Federally Qualified Health Center with a mission to provide high quality, comprehensive, primary and preventative health care services in an environment of caring, dignity and respect to all people regardless of their ability to pay. For more than fifty years, Cornerstone has been responsive to meeting the needs of the communities in which we serve with a continued emphasis on the underserved and those without access to health care regardless of race, economic status, age, sex, sexual orientation or disability.

CORNERSTONE BENEFITS:

Competitive salaries Health Benefits Retirement plan Paid Time Off Sick Time Flexible Spending Dependent Care Paid Holidays

Job Duties:

  • Assists patients in obtaining prior authorizations for treatment requiring insurance pre-authorization.
  • Handles all prior authorization submissions to proper insurances.
  • Documents in EMR authorization status, actions, and outcomes.
  • Communicates well with internal providers to obtain all the required information to submit prior authorization efficiently.
  • Has medical terminology knowledge, i.e. ICD, CPT, Procedure Codes/Names, & Test Names.
  • Responsible for notifying the appropriate internal departments of any information that they need to be aware of, including complaints or adverse event notifications.
  • Communicates and builds relationships with insurance carriers and servicing providers or facilities.
  • Schedule peer to peer meeting between CFH provider and insurance company for prior authorization denials.
  • Request and prepare supporting documentation for the medical necessity for the service being authorized, examples include medical records, labs, previous prior authorization(s), appeals, denials and prescriptions.
  • Sorts daily work queues and is accountable to identify and process the daily work.
  • Performs initial insurance benefit verification and pre-surgical authorization for new OB/GYN or Podiatry surgical cases.
  • Advises Provider and patients of any changes or cancellations of surgical/procedure bookings.
  • Fields phone calls from staff and service providers and resolves inquiries related to prior authorizations.
  • Easily manages multiple authorization requests at once.
  • Exemplifies excellent customer service with patients, visitors, and other employees; shows courtesy, friendliness, helpfulness, and respect.
  • Consistently demonstrates respect for the capabilities, different cultures and/or personalities of internal and external customers.
  • Maintains and ensures patient privacy and confidentiality.
  • Takes the initiative to proactively assist others.
  • Maintains open and effective communication with providers and employees to ensure quality.
  • Perform other related duties as assigned

Requirements:

  • Bilingual (English & Spanish)
  • At least one-year clerical experience in a health-related field
  • Knowledge of data entry
  • Pleasant telephone manner

Apply