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Prior Authorization Jobs in Reston, VA (NOW HIRING)

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$14

$22

$34

How much do prior authorization jobs pay per hour?

As of Sep 14, 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 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.
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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, 78% Full Time, 18% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $45,929 per year, or $22.1 per hour.

Access & Reimbursement Manager

Washington, DC • On-site

The Lockwood Group®
See more jobs at The Lockwood Group®external

Other

Posted 9 days ago

Job description

About Stratis Group:

Stratis Group is an independent pharmaceutical consulting firm that specializes in commercialization throughout a brand's lifecycle, our core passions include: market access, patient services, field reimbursement, and data-driven analytics.

Summary:

In this contracted, field-based role, the Access & Reimbursement Manager will serve as a dedicated access and reimbursement resource within an assigned territory. The ARM will support appropriate patient access by educating provider offices on payer requirements, reimbursement processes, patient support services, and approved access resources. This role will be highly visible within the organization and responsible for providing education to targeted healthcare providers and office staff, which may include primary care, cardiology, and other client-defined specialties or account types, regarding access services and reimbursement solutions specific to the product and therapeutic area. (Cardiovascular). The ARM will develop and execute a territory access plan, prioritize accounts based on client-defined objectives, coordinate compliantly with sales, market access, patient services, hub/specialty pharmacy partners, and other matrix stakeholders, and document activities in the approved CRM platform. Responsibilities include ensuring understanding of the reimbursement process particularly in Retail Pharmacy, field reimbursement services, and payer landscape. The ARM will abide in a compliant manner and will work closely within a defined set Rules of Engagement (ROE). As permitted under the approved program design and ROE, the ARM may support patient-level access and reimbursement issue resolution and may access PHI only as authorized and required to perform the role. In this role, the ARM will demonstrate a compliant and consultative approach to help offices obtain insurance authorization and/or reimbursement of products for appropriate patients. The ARM will have a direct impact on providing a positive experience for both the HCP Customer and Patient.

Additional responsibilities include:
  • Manage daily activities that support appropriate patient access to our client's products in the provider offices and work as a liaison to other patient assistance and access support services offered by our clients.
  • Expert in providing general education on Retail and Specialty Pharmacy drug Prior Authorizations, Appeals, and Denials
  • Provide in-person customer visits.
  • Participate in client meetings as appropriate. Participate in regularly scheduled internal team and cross-functional meetings and calls. Input call activity into customer CRM, as appropriate.
  • Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior authorization trends, denial patterns, and other access barriers. Communicate relevant changes and field insights to appropriate internal stakeholders in a timely and compliant manner. Provide office education and awareness during the entire access process which may include formulary coverage/utilization management criteria, coding, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
  • Use only client-approved materials, messaging, processes, and resources when engaging with healthcare providers, office staff, and field partners.
  • Identify and communicate field access insights, payer trends, office workflow barriers, and reimbursement challenges to appropriate internal stakeholders to support continuous improvement
  • Recognize and report adverse events, product complaints, and other reportable information in accordance with client policy and applicable requirements.
Desired Job Requirements:
  • 3+ years of experience in one or more of the following areas: Managed Care, Field Reimbursement, Patient Services, and/or Sales (Specialty or Biologics), or healthcare provider office practice management
  • 4-year degree in related field or equivalent experience
  • Cardiovascular/Cardiology and Hospital Healthcare Systems experience a plus
  • The ability to travel 3-4 days a week, with overnights (as needed), must reside within the Territory
  • Solution oriented mindset, strong business acumen, & strong analytic capabilities
  • Experience and understanding of Retail Pharmacies & Specialty Pharmacies
  • Demonstrated ability to educate offices on access processes and issue resolution
  • Experience educating HCPs and office staff on client specific Patient Service programs (i.e. copay)
  • Experience delivering educational presentations in person and/or via technology platforms such as Zoom, Webex, and/or Teams
  • Advanced knowledge of medical insurance terminology
  • Knowledge of Centers of Medicare & Medicaid Services (CMS) policies and processes with expertise in Medicare (Part D for Pharmacy Benefit products)
  • Proven ability to develop and maintain trusted relationships with internal partners and effectively work well in teams
  • Ability to manage ambiguity & problem solve
  • Prepare and submit appropriate expense reports in a timely fashion
  • Valid Driver's License
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