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Prior Authorization Jobs in Virginia (NOW HIRING)

WomanCare Centers

Prior Authorization Nurse

Norfolk, VA · On-site

$25 - $31/hr

WomanCare Centers Prior Authorization Nurse We are a busy, patient-centered OB/GYN outpatient practice dedicated to providing compassionate, comprehensive care to women at every stage of life. Our ...

VSI

Insurance Authorization Specialist

Reston, VA · On-site

$19 - $25.25/hr

This role is responsible for obtaining prior authorization for various medical procedures, services, and medications. This is a full-time position working out of our Reston office. The position ...

VSI

Insurance Authorization Specialist

Reston, VA · On-site

$52 - $68/hr

This role is responsible for obtaining prior authorization for various medical procedures, services, and medications. This is a full-time position working out of our Reston office. The position ...

Riverside

$23.90 - $31.10/hr

Overview Supports patient access to specialty medications by coordinating prior authorizations, benefit investigations, and patient assistance programs under the supervision of a licensed pharmacist ...

Riverside Health System Non-Providers

$23.90 - $31.10/hr

Overview Supports patient access to specialty medications by coordinating prior authorizations, benefit investigations, and patient assistance programs under the supervision of a licensed pharmacist ...

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All JobsPrior Authorization JobsPrior Authorization Jobs in Virginia

Prior Authorization information

See Virginia salary details

$13

$20

$31

How much do prior authorization jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for prior authorization in Virginia is $20.71, according to ZipRecruiter salary data. Most workers in this role earn between $17.16 and $22.88 per hour, depending on experience, location, and employer.

What is prior authorization?

Prior authorization is a process used by health insurance companies to determine if they will cover a prescribed procedure, service, or medication. Before the provider delivers the service, they must receive approval from the insurer. This process helps control costs and ensures that the service or medication is medically necessary. It often involves submitting documentation and waiting for a decision, which can sometimes delay patient care. Patients and providers should check with insurance companies to understand which services require prior authorization.

What are the key skills and qualifications needed to thrive as a prior authorization specialist, and why are they important?

To thrive as a Prior Authorization Specialist, you need strong knowledge of medical terminology, insurance processes, and healthcare regulations, typically supported by a high school diploma or associate degree in a healthcare-related field. Familiarity with electronic medical records (EMR) systems, insurance portals, and authorization management software is essential. Attention to detail, effective communication, and problem-solving abilities help you navigate complex cases and collaborate with providers and payers. These skills ensure accurate and timely processing of authorizations, minimizing delays in patient care and reducing administrative errors.

What are some common challenges faced by prior authorization specialists, and how can applicants prepare for them?

Prior Authorization specialists often encounter challenges such as navigating complex insurance policies, managing high volumes of requests, and communicating effectively with both healthcare providers and insurance representatives. To prepare for these challenges, applicants should develop strong organizational skills, attention to detail, and a good understanding of medical terminology and insurance guidelines. Familiarity with electronic health records (EHR) systems and the ability to multitask in a fast-paced environment are also valuable assets in this role.

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

AspectPrior AuthorizationMedical Billing Specialist
CredentialsTypically requires knowledge of insurance policies, healthcare regulations, and sometimes certifications like NCQA or AHIPRequires knowledge of coding, billing procedures, and often certifications like CPC or CCS
Work EnvironmentHealthcare provider offices, insurance companies, or hospitalsMedical offices, billing companies, or healthcare facilities
Employer & Industry UsageUsed by healthcare providers and insurers to approve treatments or proceduresUsed by healthcare providers and billing companies to process claims and payments

While both roles are essential in healthcare administration, Prior Authorization focuses on obtaining approval for treatments, whereas Medical Billing Specialists handle the financial aspects of claims processing. Understanding their differences helps clarify their distinct responsibilities within the healthcare system.

How do I become a prior authorization specialist?

To become a prior authorization specialist, you typically need a high school diploma or equivalent, along with knowledge of medical billing and coding. Relevant skills include attention to detail, communication, and familiarity with insurance policies and electronic health record systems. Certification in medical billing or coding can enhance job prospects.

What career paths follow prior authorization?

Careers following prior authorization include roles such as medical billers, claims processors, healthcare administrators, and utilization review specialists. These positions often require knowledge of insurance policies, medical coding, and healthcare regulations, and may involve certifications like CPC or CCS. Advancement can lead to supervisory or managerial roles within healthcare administration or insurance companies.

What is a prior authorization job?

A prior authorization job involves reviewing and processing requests from healthcare providers to approve specific medical treatments, medications, or procedures before they are administered. The role requires knowledge of insurance policies, medical terminology, and attention to detail, often utilizing electronic health record systems. It is essential for ensuring that treatments meet insurance criteria and are covered under the patient's plan.
More about Prior Authorization jobs

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 Prior Authorization jobs in Virginia?

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

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

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

What cities in Virginia are hiring for Prior Authorization jobs?

Cities in Virginia with the most Prior Authorization job openings:

Prior Authorization jobs near you
Infographic showing various Prior Authorization job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $43,087 per year, or $20.7 per hour.

Prior Authorization Nurse

WomanCare Centers

Norfolk, VA • On-site

$25 - $31/hr

Full-time

PTO

Posted 18 days ago

Job description

WomanCare Centers
Prior Authorization Nurse 

We are a busy, patient-centered OB/GYN outpatient practice dedicated to providing compassionate, comprehensive care to women at every stage of life. Our team values communication, collaboration, and continuity of care—both in and out of the office. 

We’re seeking an experienced Medication Prior Authorization Nurse to join our dynamic team in an in-person, non-remote position. The primary focus of this role is the timely and accurate management of medication prior authorizations, working closely with providers, pharmacies, insurance companies, and patients to facilitate access to prescribed medications. 

Responsibilities: 
  • Manage medication prior authorizations as the primary responsibility of the position, including initiating, completing, submitting, and tracking prior authorization requests. 
  • Review medication orders and insurance requirements to determine appropriate prior authorization processes and required documentation. 
  • Gather and submit supporting clinical documentation, including diagnoses, treatment history, laboratory results, and other information required for authorization. 
  • Monitor pending prior authorizations and proactively follow up to ensure timely resolution and minimize delays in patient treatment. 
  • Assist with appeals, reconsiderations, peer-to-peer requests, and alternative medication options when prior authorization requests are denied, as directed by the provider.
  • Maintain accurate and timely documentation of all prior authorization activities in the electronic health record (EHR). 
  • Process medication refill requests as appropriate, ensuring clinical appropriateness and adherence to established protocols. 
  • Stay current with payer requirements, medication authorization processes, and changes that may affect patient access to medications. 
  • Other duties as assigned. 

Qualifications Desired:
  • Minimum of 2 years of nursing experience in Prior Authorizations. 
  • Strong clinical assessment, critical thinking, and problem-solving skills. 
  • Excellent communication, organization, documentation, and time-management skills. 
  • Strong attention to detail and ability to manage multiple prior authorizations and follow-up tasks simultaneously. 
  • Ability to work independently while collaborating effectively with providers, pharmacies, insurance companies, and members of the care team. 
  • Compassionate, patient-centered approach to care. 
  • Ability to work in person; this position is not eligible for remote work. 
  • Familiarity with medication formularies.
  • Knowledge of common OB/GYN conditions, including prenatal care, contraception, menstrual issues, menopause, infections, and pregnancy complications. 

Why Join Our Team? 
  • Paid time off that increases with tenure. 
  • Major federally recognized holidays off with pay. 
  • Competitive benefits package with optional supplemental benefits. 
  • Leadership dedicated to cultivating and maintaining a positive environment that encourages professional growth. 
  • Opportunities to take on healthy challenges and develop your clinical and administrative skills. 
  • A collaborative team environment with coworkers who encourage and support one another in achieving success.