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Home Based Prior Authorization Jobs in Virginia (NOW HIRING)

MFA

Prior-Authorization Technician- Pharmacy

Arlington, VA · On-site

$23.46 - $30.50/hr

Position Summary The Prior Authorization Technician will process prior authorizations and locate ... based practices in DC, Maryland, and Virginia. Given its geographic location in central NW ...

Riverside

$23.90 - $31.10/hr

Newport News, Virginia Hiring Range $23.90 - $31.10/Hourly Actual pay is determined based on job ... Follows prior authorization and/or patient assistance workflows and policies/procedures.

Riverside Health System Non-Providers

$23.90 - $31.10/hr

Newport News, Virginia Hiring Range $23.90 - $31.10/Hourly Actual pay is determined based on job ... Follows prior authorization and/or patient assistance workflows and policies/procedures.

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Home Based Prior Authorization information

What is a home based prior authorization specialist?

A Home Based Prior Authorization specialist is a healthcare professional who works remotely to review and process prior authorization requests for medical procedures, medications, or services. Their main role is to ensure that treatments and prescriptions meet insurance requirements before approval, helping patients receive necessary care while managing costs for providers and insurers. These specialists communicate with healthcare providers, insurance companies, and sometimes patients, using secure online systems to perform their duties from home. Their work is critical in streamlining healthcare access and preventing unnecessary delays in treatment.

What are the key skills and qualifications needed to thrive as a home based prior authorization specialist?

To thrive as a Home Based Prior Authorization Specialist, you need a solid understanding of medical terminology, insurance policies, and healthcare procedures, often supported by experience in medical billing or coding. Familiarity with electronic health record (EHR) systems, payer portals, and prior authorization software is typically required, along with certifications like CPC or CPB being advantageous. Strong attention to detail, effective communication, and the ability to work independently are valuable soft skills in this remote role. These competencies ensure timely and accurate authorization processing, reduce claim denials, and support seamless patient care coordination.

What are some common challenges faced in a home based prior authorization role and how can they be managed?

One common challenge in a home-based prior authorization role is maintaining effective communication with healthcare providers and insurance companies while working remotely. This can be managed by utilizing secure digital communication tools and staying organized with thorough documentation. Another challenge is staying updated on frequently changing insurance policies and regulations, which can be addressed by participating in ongoing training and regularly reviewing updates from payers. Additionally, managing distractions and maintaining productivity at home requires setting a dedicated workspace and a structured daily routine.

What is the difference between Home Based Prior Authorization vs Medical Coder?

AspectHome Based Prior AuthorizationMedical Coder
CredentialsTypically requires healthcare experience, knowledge of insurance policies, and sometimes certifications in healthcare administrationRequires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentRemote, healthcare or insurance company settingRemote or on-site, healthcare facility or billing office
Industry UsageUsed in insurance, healthcare administration, and utilization reviewUsed in medical billing, coding, and health information management

Home Based Prior Authorization specialists focus on reviewing and approving insurance requests for medical procedures, requiring healthcare knowledge. Medical Coders translate medical records into codes for billing, requiring coding certifications. While both roles are remote and healthcare-related, they serve different functions within the healthcare industry.

What are the most commonly searched types of Prior Authorization jobs in Virginia?

The most popular types of Prior Authorization jobs in Virginia are:

What are popular job titles related to Home Based Prior Authorization jobs in Virginia?

For Home Based Prior Authorization jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Home Based Prior Authorization jobs in Virginia look for?

The top searched job categories for Home Based Prior Authorization jobs in Virginia are:

What cities in Virginia are hiring for Home Based Prior Authorization jobs?

Cities in Virginia with the most Home Based Prior Authorization job openings:

Home Based Prior Authorization jobs near you

Prior-Authorization Technician- Pharmacy

GW MFA

Arlington, VA • On-site

$48K - $63K/yr

Full-time

Re-posted 15 days ago

Job description

Position Summary

The Prior Authorization Technician will process prior authorizations and locate foundation assistance for GW Medical Faculty Associates providers.

Essential Duties and Responsibilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned.

Under the direct supervision of a licensed Pharmacist:

  • Initiate prior authorizations for medications and work with providers on completion
  • Confirm patient demographics are accurate and insurance information is correct
  • Communicate with the clinical team and patients about prior authorization status and provide updates accordingly
  • Identify patient foundation assistance and manufacturer copay assistance programs
  • Follow up with the pharmacy to ensure the medication is in process after approval received
  • Process prior authorization renewals
  • Work with the provider to resolve prior authorization denials, peer-to-peer reviews, and denials
  • At all times, maintain a courteous interaction with patients, visitors, departments, and medical personnel
  • Refer issues that require professional judgment to a pharmacist for follow-up
  • Other duties assigned

Minimum Qualifications

Education

  • High school diploma or an equivalent combination of education, training, and experience

Licenses/Certifications

  •  A valid and active DC, MD, or VA pharmacy license is required.

Experience

  • A minimum of 2 years of Pharmacy Technician experience in retail, specialty, or mail-order pharmacy and a pharmacy license ( Must have  a DC MD or VA active pharmacy license 
    • A minimum of 2 years in an alternative healthcare role (i.e. Certified Nurse Assistant, Medical Assistant, Licensed Practical Nurse) will be considered 

Physical Requirements

  • Stand, walk, bend, twist, and reach for long periods of time in a clinical setting.
  • Must be able to occasionally lift or carry and push or pull up to 100 lbs. as part of the role
  • Regularly exposed to healthcare settings that may require personal protective equipment
  • Requires manual dexterity to operate a computer keyboard, calculator, copier machine, and other equipment.

About GW MFA

MFA physicians provide comprehensive patient care, offering one practice for the whole person with 52 medical and surgical specialties. As members of the GW School of Medicine and Health Sciences faculty, MFA providers are teachers and mentors for medical students, residents, fellows, and researchers preserving the rich tradition of academics, research, and healing. In addition to maintaining a closely integrated alliance with The George Washington University and The George Washington University Hospital (GWUH) which is separately owned and operated by Universal Health Services (UHS), the GW MFA has active referring relationships with 12 area hospitals.

The GW MFA’s leading healthcare presence in the DC metro region is complemented by a network of community-based practices in DC, Maryland, and Virginia. Given its geographic location in central NW Washington, DC, and proximity to more than 175 resident embassies, the MFA continues to evolve its international clinical outreach.

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