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Prior Authorization Jobs in Virginia (NOW HIRING)

ARM Consulting

Reimbursement Specialist

Fort Belvoir, VA · On-site

$21.75 - $30/hr

Prior Authorization Support & Access Navigation * * Review payer-specific prior authorization requirements * * Educate provider offices regarding payer documentation expectations * * Support ...

Sentara Healthcare

Authorization Coordinator

Norfolk, VA · On-site +1

$18 - $22.25/hr

The Authorization Coordinator is responsible for review of clinical information received from ... Validates accuracy of insurance enrollment information in the system prior to authorizing services.

Integrated Resources INC

Pharmacy Technician

Richmond, VA

$17.25 - $21/hr

Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria. Determines appropriateness for ...

Albanymed

Authorization Specialist I

Broadway, VA · On-site

$49K - $69K/yr

This includes securing Referral and Authorization. Insurance Verification and Benefit interpretation to discern insurance guidelines are being adhered to. Ability to interact with patients and ...

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All JobsPrior Authorization JobsPrior Authorization Jobs in Virginia

Prior Authorization information

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$13

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$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.

Specialty Pharmacy Technician - as needed

Riverside Health System

Newport News, VA • On-site

$23.90 - $31.10/hr

Part-time

Re-posted 13 days ago

Job description

Newport News, Virginia
Hiring Range
$23.90 - $31.10/HourlyActual pay is determined based on job-related factors such as relevant experience, education, credentials, skills, internal equity, and business needs.
Overview
Supports patient access to specialty medications by coordinating prior authorizations, benefit investigations, and patient assistance programs under the supervision of a licensed pharmacist, while serving as a liaison between patients, providers, payers, and manufacturers to facilitate timely medication approval and therapy initiation. Ensures accurate documentation, clear communication, and compliance with specialty pharmacy accreditation standards and all applicable state and federal regulations while supporting a positive patient experience.
What you will do
  • Timely process of referrals and submit clinical supporting documentation to insurance carriers, manufacturers, or foundations to expedite prior authorization and/or patient assistance processes. Collaborate with other departments to assist in obtaining prior authorizations, patient assistance medications or financial assistance. Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Follows prior authorization and/or patient assistance workflows and policies/procedures.
  • Demonstrates the ability to work independently, meet deadlines and possesses excellent time management skills. Perform tasks accurately and efficiently. Possesses excellent interpersonal, customer service and communication skills (both written and verbal); timely responses to key stakeholders.
  • Accurate documentation of all intake referrals and/or prior authorization information in patient medical record or patient assistance tracking software in compliance with policy and procedure/workflow. Completes timely documentation within the required tracking systems and retrieves necessary documentation and maintains up to date knowledge of the pharmaceutical companies' patient assistance programs.
  • Proactively tracks and manages patient refills/outreach to ensure timely prescription/infusion service.
  • Proactively works on prior authorization and patient assistance enrollments that are due to expire.
  • Secure patients' demographic and medical information in compliance with organization HIPAA policies and procedures.
  • Assists management with inspections, audits, reports and training to ensure compliance with standards and to provide quality service.

Qualifications
Education
  • Program Graduate, Pharmacy Technician Training Program or equivalent (Preferred) or
  • Program Graduate, Licensed Practical Nurse (Required) or
  • Program Graduate, Certified Medical Assistant (Required)

Experience
  • 3-4 years Experience as a Pharmacy Technician, LPN or CMA (in lieu of education) (Required)
  • 1 year Experience obtaining and managing medication prior authorization as part of job function (Preferred)
  • 1 year Prior Experience obtaining and managing patient assistance program applications (Preferred)

Skills and Abilities
  • Familiar with medical and pharmacy terminology
  • Prescription drug and over-the-counter knowledge
  • Basic math skills, including pharmaceutical calculations
  • Basic pharmacy workflow
  • Understanding pharmacy computer systems
  • Ability to navigate and read electronic health record
  • Strong written and verbal communication skills
  • Ability to prioritize, problem solve and multitask
  • Excellent customer service skills
  • Knowledge of patient assistance programs
  • Experience with prior authorization of medications
  • Strong organizational skills and detail oriented

Licenses and Certifications
  • Registered Pharmacy Technician - Virginia Department of Health Professions (VDHP) Upon Hire(Required) and
  • Pharmacy Technician Certification Board (PTCB) - Pharmacy Technician Certification Board (PTCB) PTCB or ExCPT Upon Hire(Required) or
  • Licensed Practical Nurse (LPN) - Virginia Department of Health Professions (VDHP) Upon Hire(Required) or
  • Certified Medical Assistant (CMA) - American Association of Medical Assistants (AAMA) Upon Hire(Required)
  • Advanced certification in specialty pharmacy field (PTCB, ASHP, NCODA and other approved programs) (Preferred)

To learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers.

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