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Medical Prior Authorization Jobs in Virginia (NOW HIRING)

ARM Consulting

Reimbursement Specialist

Fort Belvoir, VA · On-site

$21.75 - $30/hr

The Reimbursement Specialist is responsible for conducting comprehensive benefit investigations, analyzing medical and pharmacy benefit coverage, supporting prior authorization and appeal processes ...

Spine and Pain Regenerative Medicine

Be Seen First

Receptionist Front Desk/medical assistant

Fairfax, VA · On-site

$18 - $21/hr

Verify insurance and collect patient payments * Assist with referrals and prior authorizations * Maintain medical records and patient information * Room patients and obtain vital signs * Update ...

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Medical Prior Authorization information

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$12

$22

$54

How much do medical prior authorization jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for medical prior authorization in Virginia is $22.75, according to ZipRecruiter salary data. Most workers in this role earn between $17.40 and $24.09 per hour, depending on experience, location, and employer.

What is medical prior authorization?

Medical prior authorization is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication before it is provided. Providers must submit a request for approval, including supporting documentation, to the insurance company. This process helps ensure that the service is medically necessary and meets the insurer's coverage criteria. Obtaining prior authorization does not guarantee payment, but it is often required to avoid claim denials and delays in patient care.

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

To thrive as a Medical Prior Authorization Specialist, you need in-depth knowledge of insurance policies, medical terminology, and healthcare regulations, typically supported by experience in medical billing or healthcare administration. Proficiency in prior authorization software, electronic health record (EHR) systems, and understanding of payer portals is essential. Strong attention to detail, excellent communication, and organizational skills help you navigate complex approval processes and interact effectively with providers and insurers. These skills ensure timely and accurate authorization of medical services, reducing delays in patient care and minimizing claim denials.

What are some common challenges faced in a medical prior authorization role, and how are they typically addressed?

A common challenge in Medical Prior Authorization is managing high volumes of requests while ensuring timely and accurate approvals. Specialists often deal with complex insurance policies and must coordinate closely with healthcare providers and insurance companies to obtain necessary documentation. To address these challenges, most teams utilize specialized software and standardized workflows, and regular training is provided to stay updated on changing regulations. Strong communication and organizational skills are essential for navigating these complexities and ensuring patients receive prompt care.

What is the difference between Medical Prior Authorization vs Medical Claims Specialist?

AspectMedical Prior AuthorizationMedical Claims Specialist
Required credentialsOften requires healthcare or insurance-related certificationsTypically requires insurance or billing certifications
Work environmentHealthcare offices, insurance companies, or hospitalsInsurance companies, healthcare providers, or billing departments
Employer and industry usageUsed in healthcare and insurance to approve proceduresUsed in insurance to process and adjudicate claims
Common search and comparison intentUnderstanding approval process for treatmentsUnderstanding claims processing and reimbursement

Medical Prior Authorization involves obtaining approval from insurance before certain treatments or procedures, ensuring coverage. Medical Claims Specialists handle the processing and reimbursement of insurance claims after services are provided. While both roles work within healthcare insurance, prior authorization focuses on pre-approval, whereas claims specialists manage post-service billing and claims processing.

How do I become a medical prior authorization specialist?

To become a medical prior authorization specialist, candidates typically need a high school diploma or equivalent, along with knowledge of medical billing, insurance processes, and healthcare regulations. Relevant skills include attention to detail, communication, and familiarity with electronic health record (EHR) systems; certifications such as the Certified Medical Administrative Specialist (CMAS) can enhance job prospects.

What career paths follow medical prior authorization?

Medical prior authorization professionals often advance to roles such as healthcare compliance specialists, insurance claims analysts, or healthcare managers. They may also pursue certifications in healthcare administration or coding to expand their career opportunities within the healthcare and insurance industries.

What cities in Virginia are hiring for Medical Prior Authorization jobs?

Cities in Virginia with the most Medical Prior Authorization job openings:

Medical Prior Authorization jobs near you
Infographic showing various Medical Prior Authorization job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 71% Full Time, 22% Part Time, and 6% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $47,323 per year, or $22.8 per hour.

Reimbursement Specialist

ARM Consulting

Fort Belvoir, VA • On-site

$21.75 - $30/hr

Full-time

Re-posted 2 days ago

Job description

Position Description: 

The Reimbursement Specialist serves as a highly skilled reimbursement and patient access resource within a manufacturer-sponsored Patient Support Services (HUB) program. As an employee of the HUB services vendor, this role supports patients, healthcare providers, specialty pharmacies, and internal stakeholders by facilitating timely access to prescribed therapies through expert navigation of complex healthcare reimbursement processes. 

The Reimbursement Specialist is responsible for conducting comprehensive benefit investigations, analyzing medical and pharmacy benefit coverage, supporting prior authorization and appeal processes, identifying payer-related access barriers, coordinating with specialty pharmacy partners, and assisting healthcare providers with reimbursement-related  

requirements.
This role requires advanced knowledge of commercial and government payer environments, specialty pharmaceutical reimbursement pathways, patient access programs, and healthcare benefit structures. The Reimbursement Specialist must demonstrate the ability to independently manage complex cases, interpret payer requirements, communicate effectively with healthcare professionals, and deliver exceptional service while maintaining strict compliance with manufacturer-approved program guidelines. The successful candidate will serve as a trusted reimbursement resource within a high-performing HUB environment and will contribute to improving patient access across multiple therapeutic areas and pharmaceutical products


Key Responsibilities:  

  • Comprehensive Benefit Investigation & Reimbursement Analysis 
    • Conduct detailed medical and pharmacy benefit investigations for assigned products and therapeutic area
    • Analyze patient insurance coverage including: 
    • Commercial insurance
    • Medicare Part B
    • Medicare Part D
    • Medicaid
    • Managed Medicaid
    • Employer-sponsored plans
    • Government-sponsored plans
    • Determine benefit coverage requirements, including: 
    • Deductibles 
      • Prior Authorization Support & Access Navigation 
        • Review payer-specific prior authorization requirements
        • Educate provider offices regarding payer documentation expectations
        • Support completion and submission of prior authorization requests
        • Monitor authorization progress and communicate status updates
        • Identify missing information impacting approval timelines
        • Support escalation of complex access issues
        • Assist providers with understanding payer processes without influencing clinical decision-making
      • Appeals & Denial Resolution Support 
        • Review payer denial information and identify appropriate next steps
        • Support healthcare providers with appeal documentation requirements
        • Coordinate collection of supporting information
        • Track appeal submissions and payer outcomes
        • Identify payer trends impacting patient access
        • Escalate recurring barriers to HUB leadership
      • Specialty Pharmacy & Distribution Support 
        • Coordinate reimbursement activities with specialty pharmacy partners. 
        • Support prescription triage and fulfillment workflows. 
        • Resolve reimbursement-related delays impacting therapy initiation. 
        • Communicate coverage outcomes and access requirements. 
        • Understand specialty pharmacy network requirements and payer mandates. 
        • Assist with transitions between specialty pharmacies when required 
      • Patient Assistance & Affordability Program Support  
        • Educate patients and providers regarding available manufacturer-sponsored support programs
                • Assess patient eligibility for applicable affordability program
                • Assist with documentation requirements
                • Ensure enrollment activities are completed accurately and compliantly
              • Provider Education & Customer Support  
              • Case Management & Documentation 


              Minimum Qualifications: 

              Education 

              • Bachelor's degree in healthcare administration, nursing, pharmacy, life sciences, business, public health, or related field 
              • In lieu of a bachelor's degree, a minimum of five (5) years of progressive experience in:  
                • Pharmaceutical HUB services 
                • Specialty pharmacy 
                • Patient access services 
                • Healthcare reimbursement 

                Experience 

                • Experience with three (3) years of healthcare reimbursement or patient access 
                • Experience working with: 
                  • Commercial payers 
                  • Medicare 
                  • Medicaid 
                  • Specialty pharmacies 
                  • Prior authorization platforms 



                Required Skills:  

                • Knowledge & Technical Expertise
                  of: 
                  • Medical and pharmacy benefit structures 
                  • Specialty pharmacy workflows 
                  • Prior authorization processes 
                  • Appeals processes 
                  • Payer policies 
                  • PBM operations 
                  • Specialty medication access pathways 
                  • Copay assistance programs 
                  • Patient assistance programs 
                  • Reimbursement terminology 
                • Technology Skills
                  with: 
                  • HUB case management platforms 
                  • CRM systems 
                  • Specialty pharmacy portals 
                  • Electronic prior authorization systems 
                  • Payer portals 
                  • Microsoft Office Suite 
                  • Reporting dashboards 



                Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States. 

                ARM is an EEO and Affirmative Action Employer of Females/Minorities/Veterans/Individuals with Disabilities. 

                All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law. 

                ARM is an Equal Opportunity Employer