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Prior Authorization Jobs in Reston, VA (NOW HIRING)

American Oncology Network

Financial Counselor

Bethesda, MD · On-site

$20.09 - $33.48/hr

Performs the quality control function for pre-certification and prior authorization. The Financial Counselor ensures the patients' insurance benefits are kept up to date in the electronic medical ...

American Oncology Network

Financial Counselor

Bethesda, MD · On-site

$20.09 - $33.48/hr

Performs the quality control function for pre-certification and prior authorization. The Financial Counselor ensures the patients' insurance benefits are kept up to date in the electronic medical ...

J5 Consulting

Assessment & Authorization Specialist

Herndon, VA · On-site

$18.50 - $24.75/hr

  • Medical

  • Retirement

  • PTO

... Authorization (A&A) process, and develop a Systems Security Plan (SSP). Required skills and ... You will be asked to provide clearance verification information prior to an offer of employment.

J5 Consulting

Assessment & Authorization Specialist

Herndon, VA · On-site

$18.50 - $24.75/hr

  • Medical

  • Retirement

  • PTO

... Authorization (A&A) process, and develop a Systems Security Plan (SSP). Required skills and ... You will be asked to provide clearance verification information prior to an offer of employment.

Amazon

Sr. Specialist, Work Authorization

Arlington, VA · On-site

$20.75 - $27.50/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Work Authorization program. This team ensures all Amazon employees are legally authorized to work and remain authorized throughout their employment, mitigating risks of non-compliance, financial ...

CareMetx

Patient Navigator Social Worker

Bethesda, MD · On-site

$21.25 - $29/hr

Services provided by the Hub staff include benefit coverage investigation, prior authorization requirements analysis, product delivery and non-clinical case management. Bilingual English/Spanish is ...

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All JobsPrior Authorization JobsPrior Authorization Jobs in Reston, VA

Prior Authorization information

See Reston, VA salary details

$14

$22

$34

How much do prior authorization jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for prior authorization in Reston, VA is $22.08, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $24.38 per hour, depending on experience, location, and employer.

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 and gain experience in healthcare or insurance billing. Relevant skills include knowledge of medical terminology, insurance policies, and proficiency with electronic health record (EHR) systems; certifications such as Certified Medical Administrative Assistant (CMAA) can also enhance job prospects.

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.

What are the career paths in prior authorization?

Careers in prior authorization typically include roles such as prior authorization specialists, medical reviewers, and healthcare administrators. Advancement can lead to supervisory or managerial positions, and professionals often develop skills in healthcare regulations, insurance policies, and medical coding. Certifications in medical billing and coding can enhance career growth in this field.

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.
More about Prior Authorization jobs

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

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Cities near Reston, VA with the most Prior Authorization job openings:

Prior Authorization jobs near you
Infographic showing various Prior Authorization job openings in Reston, VA as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 19% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution, with an average salary of $45,929 per year, or $22.1 per hour.

Clinical and Technical Call Center Pharmacy Technician

Accede Solutions Inc.

Mclean, VA • On-site

$18.75 - $23/hr

Other

Re-posted 11 days ago

Job description

Pharmacy Technician

The Pharmacy Technician for the PBM clinical and technical call center is expected to be a subject matter expert in areas of pharmacy knowledge as well as call center operations. Duties will include, but are not limited to, answering incoming calls and making outgoing calls for members, medical providers, or pharmacy providers, appropriate processing of prior authorization requests, and assisting members and providers with inquiries through other media platforms as needed (fax, web, e-mail).

Responsibilities:

  • Remain compliant with all PHI protocols and requirements including the handling of company confidential data according to policy and guidelines. Adheres to existing security policies and procedures.
  • Process submitted prior authorization requests within the required time frame mandated by the State client
  • Completion of approval process for prior authorizations where all criteria is met and clinical judgement of a pharmacist is not required
  • Complete necessary communication with providers regarding status of their authorization submission or any other inquiries
  • Follow standard operating procedures to receive incoming calls and use learned knowledge and resources to resolve the call on initial contact
  • Provide a positive experience when communicating with members and providers
  • Complete outreach to providers to obtain information when required
  • Appropriately document all inquiries received via phone, fax, or email for members or providers
  • Provide a high level of customer care with our members and providers
  • Meet all department requirements, goals, and performance expectations
  • Complete all tasks assigned within regulatory guidelines
  • Actively identify areas of inefficiencies and provide innovative suggestions to leadership to keep processes current
  • Develops understanding of the client's business and applies knowledge to support efficient procedures and adherence to service level agreements.
  • Performs standard, recurring processing and quality tasks in support of outsourced services within a specific industry and functional area. Demonstrates knowledge and skill in assigned work processes.
  • Complete any additional job-related tasks as requested

Skills:

  • Strong verbal and written communication skills
  • Balances accuracy, quality, and efficiency in all tasks
  • A willingness and ability to learn internal systems/processes/programs, as needed
  • Basic math skills
  • Familiarity with medication names and medical terminology
  • General computer knowledge including Microsoft Office, use of the internet, and email is required
  • Ability to learn quickly, solve problems, and make decisions with minimal supervision
  • Ability to adapt and work collaboratively in a fast-paced, production environment
  • Willingness to work a flexible schedule to accommodate peak volume times
  • Excellent attention to detail
  • Effective communication skills with internal and external clients, verbally and written
  • Knowledge of pharmacy insurance claims
  • Organization skills to balance and prioritize work
  • Ability to multi-task
  • Ability to work independently and as part of a team

Requirements:

  • Must be at least 18 years of age
  • High school diploma or GED required
  • Active pharmacy technician registration with a Board of Pharmacy or certified pharmacy technician from accredited program (PTCB, ExCPT, etc.) or must obtain certification within 12 months
  • 2 years of relevant experience as a pharmacy technician in retail pharmacy, hospital pharmacy, managed care, insurance, or pharmacy benefit management

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