ZipRecruiter

Log In

1

Prior Authorization Representative Jobs in Virginia

Quipt Home Medical

Customer Service Representative

Richmond, VA · On-site

$15.75 - $21.50/hr

Customer Service Representative Position Reports To Branch Manager/CSR Director Position Summary As ... CMN Requirements and Prior Authorizations * Documentation Requirements of the Equipment * Patient ...

next page

Showing results 1-20

All JobsPrior Authorization Representative JobsPrior Authorization Representative Jobs in Virginia

Prior Authorization Representative information

See Virginia salary details

$24.3K

$43.8K

$76.3K

How much do prior authorization representative jobs pay per year?

As of Jul 27, 2026, the average yearly pay for prior authorization representative in Virginia is $43,840.00, according to ZipRecruiter salary data. Most workers in this role earn between $37,200.00 and $42,600.00 per year, depending on experience, location, and employer.

What does a prior authorization rep do?

A prior authorization representative reviews and processes requests for medical services or medications that require approval from insurance companies before treatment. They verify patient information, ensure documentation is complete, and communicate with healthcare providers and insurers to obtain necessary approvals, often using specialized software. This role helps ensure that patients receive authorized care while complying with insurance policies.

How much do precertification specialists make?

Precertification specialists, also known as prior authorization representatives, typically earn between $35,000 and $55,000 annually, depending on experience, location, and employer. They often require strong knowledge of insurance policies and medical billing systems, with some roles offering additional certifications to increase earning potential.

What are some common challenges faced by Prior Authorization Representatives, and how can they be managed?

Prior Authorization Representatives often encounter challenges such as navigating complex insurance policies, managing high volumes of requests, and dealing with time-sensitive cases. Staying up-to-date with payer requirements and utilizing electronic health record (EHR) systems can help streamline the process. Strong communication and organizational skills are essential for collaborating with healthcare providers and insurance companies to ensure timely approvals and minimize delays for patients.

What is the difference between Prior Authorization Representative vs Medical Billing Specialist?

AspectPrior Authorization RepresentativeMedical Billing Specialist
CredentialsHigh school diploma; certification often preferredHigh school diploma; certification optional
Work EnvironmentHealthcare offices, insurance companiesMedical offices, billing companies
Primary ResponsibilitiesSecuring insurance approvals for proceduresProcessing and submitting medical claims

The Prior Authorization Representative focuses on obtaining insurance approvals before procedures, while the Medical Billing Specialist handles billing and claims processing after services are rendered. Both roles require knowledge of insurance policies and healthcare documentation, but they differ in their primary functions within the healthcare revenue cycle.

What does a Prior Authorization Representative do?

A Prior Authorization Representative is responsible for reviewing and processing requests for prior authorization of medical procedures, medications, or services. They work with healthcare providers, insurance companies, and patients to ensure that the necessary documentation is submitted and meets the insurance requirements for approval. Their role helps facilitate timely access to medical care by verifying coverage and resolving any issues that may delay treatment. Excellent communication and organizational skills are important for this position.

Is prior authorization a stressful job?

Prior Authorization Representatives often work in fast-paced healthcare environments where accuracy and efficiency are important. The job can be stressful due to tight deadlines, high call volumes, and the need to interpret complex insurance policies, but experience and strong organizational skills can help manage the workload.

What are the key skills and qualifications needed to thrive as a Prior Authorization Representative, and why are they important?

To thrive as a Prior Authorization Representative, you need a strong understanding of healthcare insurance processes, medical terminology, and prior authorization guidelines, usually supported by a high school diploma or equivalent. Familiarity with healthcare management software, electronic medical records (EMRs), and payer-specific authorization portals is typically required. Attention to detail, problem-solving abilities, and effective communication are standout soft skills for this role. These competencies are essential to ensure timely and accurate processing of authorizations, minimize claim denials, and support patient access to necessary care.

What jobs pay 4000 a week without a degree?

Prior Authorization Representatives typically do not earn $4,000 weekly; however, some high-paying roles in sales, real estate, or specialized trades can reach that level without a degree. These jobs often require strong communication skills, experience, or certifications and may involve commission or performance-based pay structures.
What are popular job titles related to Prior Authorization Representative jobs in Virginia? For Prior Authorization Representative jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Prior Authorization Representative jobs in Virginia look for? The top searched job categories for Prior Authorization Representative jobs in Virginia are:
Prior Authorization Representative jobs near you
Infographic showing various Prior Authorization Representative job openings in Virginia as of July 2026, with employment types broken down into 93% Full Time, and 7% Part Time. Highlights an 93% In-person, and 7% Remote job distribution, with an average salary of $43,840 per year, or $21.1 per hour.
Clinical Authorization Specialist (Utilization Review)

Clinical Authorization Specialist (Utilization Review)

HALLMARK YOUTHCARE RICHMOND INC

Richmond, VA

$27 - $31/hr

Full-time

Medical, Retirement

Posted 13 days ago

Job description

As a leading Residential Treatment Center in the Greater Richmond area, Hallmark Youthcare treats adolescents with emotional and behavioral challenges triggered by trauma. Treatment is provided in a warm and friendly environment by a group of well-trained, highly motivated staff that take pride in delivering quality care in a fast-paced environment.

We are seeking a detail-oriented Clinical Authorization Specialist (Utilization Review) to join our healthcare team. The ideal candidate will have experience in prior authorizations, insurance verification, utilization review, and medical necessity determinations. This role is responsible for ensuring that medical services are appropriately authorized, clinically supported, and compliant with payer guidelines before, during, and after patient care.

The Clinical Authorization Specialist serves as a liaison between healthcare providers, insurance companies, and patients to facilitate timely approvals while minimizing denials and delays in care.

In addition, this role maintains communication with referral sources (CSA/FAPT/IACCT) to coordinate placement and reimbursement standards for transfers from emergency placements and document submission to Magellan for Medicaid consideration.

Key Responsibilities
  • Master's degree in health services field.
  • Review and process prior authorization requests for medical procedures, diagnostic testing, medications, therapies, and specialty services.
  • Evaluate clinical documentation to determine medical necessity using payer guidelines, evidence-based criteria, and insurance policies.
  • Perform prospective, concurrent, and retrospective utilization reviews.
  • Communicate with physicians, nurses, case managers, and insurance representatives to obtain required clinical documentation.
  • Submit authorization requests and monitor status through payer portals and electronic health record (EHR/EMR) systems.
  • Track authorization approvals, denials, appeals, and expiration dates to ensure continuity of care.
  • Identify incomplete or missing documentation and coordinate with providers to obtain necessary information.
  • Maintain accurate records of all authorization activities, communications, and determinations.
  • Stay current on payer policies, CMS regulations, and utilization management best practices.
  • Assist with appeals and peer-to-peer review coordination when necessary.
  • Meet productivity, turnaround time, quality, and compliance standards.

Required Qualifications

  • High school diploma or equivalent required; Associate's or Bachelor's degree in a healthcare-related field preferred.
  • Minimum of 2 years of experience in prior authorization, utilization review, medical insurance, case management, including admissions.
  • Strong understanding of commercial insurance, Medicare, Medicaid, and managed care plans.
  • Experience working with electronic medical records (EMR/EHR) and payer authorization portals.
  • Excellent organizational, analytical, and problem-solving skills.
  • Strong verbal and written communication abilities.
  • Ability to prioritize multiple tasks in a fast-paced healthcare environment.

Benefits:

Set schedule Monday- Friday 9 am- 5pm

Full benefit package available

Matching 401K

Time off accrued each payroll

Free employee meals