ZipRecruiter

Log In

1

Director Insurance Prior Authorization Jobs (NOW HIRING)

CareMed Specialty Pharmacy

$23 - $25/hr

Pharmacy Prior Authorization Specialist - CareMed Specialty Pharmacy Buffalo, NY | Full-Time | ... Company Paid Life Insurance; and Short/Long-Term Disability Why Join Us? * A career with purpose:

BlinkRx

Prior Authorization Specialist

Pittsburgh, PA · On-site

$17.50 - $23.25/hr

Identify the correct prior authorization form required for the patient's insurance provider * Coordinate with prescribers and medical offices to ensure applicable information is translated onto prior ...

HaysMed

Prior Authorization Representative

Hays, KS · On-site

$18 - $26/hr

A Hospital Prior Authorization Representative assesses patient medical records, prepares and ... Collect insurance/coverage information. Be able to discern what information is required based on ...

Axelon

Prior Authorization Specialist

$18.50 - $24.50/hr

Refers authorization requests that require clinical judgment to Prior Authorization Clinician, Supervisor, or Medical Director. * Meets or exceeds position quality, quantity, and data metrics and ...

next page

Showing results 1-20

All JobsInsurance Prior Authorization JobsDirector Insurance Prior Authorization Jobs

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.
More about Director Insurance Prior Authorization jobs
What cities are hiring for Director Insurance Prior Authorization jobs? Cities with the most Director Insurance Prior Authorization job openings:
What are the most commonly searched types of Insurance Prior Authorization jobs? The most popular types of Insurance Prior Authorization jobs are:
What states have the most Director Insurance Prior Authorization jobs? States with the most job openings for Director Insurance Prior Authorization jobs include:
What job categories do people searching Director Insurance Prior Authorization jobs look for? The top searched job categories for Director Insurance Prior Authorization jobs are:
Director Insurance Prior Authorization jobs near you
Infographic showing various Director Insurance Prior Authorization job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 88% Full Time, 10% Part Time, and 1% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.
PRIOR AUTHORIZATION SPECIALIST

PRIOR AUTHORIZATION SPECIALIST

Graves Gilbert Clinic

Bowling Green, KY • On-site

$17.50 - $23.25/hr

Other

Re-posted 14 days ago

Graves Gilbert Clinic rating

6.6

Company rating: 6.6 out of 10

Based on 23 frontline employees who took The Breakroom Quiz

Job description

The Prior Authorization Specialist is responsible for verifying patient eligibility and insurance benefits for clinic-administered medications. This position requires a thorough understanding of insurance terminology, benefit structures, and authorization processes to ensure accurate documentation and timely completion of prior authorization requests. The Specialist will obtain, monitor, and maintain authorizations through payer websites, fax, and telephone, including all necessary follow-up and reauthorization activities. This role supports revenue cycle accuracy and contributes to the delivery of high-quality patient care.
Key Responsibilities:

  • Initiate, monitor, and secure prior authorizations from third-party payers.
  • Maintain electronic documentation for all prior authorization activities in accordance with organizational standards.
  • Track pending authorizations and follow up within defined timeframes (7-10 days or payer-specific requirements) to support timely claims submission.
  • Obtain authorization renewals and verify active provider orders and medical necessity documentation.
  • Work collaboratively with clinicians, practice managers, and other team members to obtain clinical notes and documentation necessary for prior authorization approval.
  • Verify authorization quantities and effective dates; ensure accurate processing by third-party payers and correct loading of information in internal systems.
  • Review and confirm patient eligibility, insurance benefits, and plan requirements for clinic-administered medications.
  • Interpret payer pre-certification and authorization guidelines and ensure appropriate approvals are obtained and documented.
  • Input accurate Payer Plan ID numbers and related data into organizational systems to ensure correct billing for current and future services.
  • Determine patient financial responsibility, including coordination of benefits and other coverage considerations.
  • Organize workload and manage deadlines to prevent delays or loss of revenue due to filing limitations.
  • Maintain professional communication with all payers, clinicians, and other team members.
  • Perform additional duties as assigned.
Qualifications:
  • Prior experience in authorization processing and benefit investigation required.
  • Experience with specialty medication authorizations preferred.
  • Strong attention to detail and accuracy.
  • Excellent time management and organizational skills.
  • Proficiency in Microsoft Excel and related software applications.
  • Strong interpersonal and communication skills.
  • Ability to interpret insurance benefits, authorization guidelines, and medical terminology.
  • Ability to work collaboratively in a fast-paced, team-oriented environment.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

What Graves Gilbert Clinic employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply