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Prior Authorization Jobs in Reston, VA (NOW HIRING)

MCKESSON

Field Reimbursement Manager

Arlington, VA · On-site +1

Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage and patient communication streams. Monthly activity reporting captures ...

Chevy Chase Foot & Ankle LLC

Be Seen First

Front Desk

Silver Spring, MD · On-site

$17/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Experience with insurance prior authorization is a plus. * Excellent communication and problem-solving skills. * Reliable transportation. * A training period is provided. Compensation: $17/hour to ...

MCKESSON

Field Reimbursement Manager

Fairfax, VA · On-site +1

Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage and patient communication streams. Monthly activity reporting captures ...

MCKESSON

Field Reimbursement Manager

Alexandria, VA · On-site +1

Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage and patient communication streams. Monthly activity reporting captures ...

MCKESSON

Field Reimbursement Manager

Woodbridge, VA · On-site +1

Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage and patient communication streams. Monthly activity reporting captures ...

CareMetx

Director, Pharmacy Operations

Bethesda, MD · On-site

$137K - $182K/yr

Prior authorization (PA) and appeals * Patient enrollment and case management * Operationalize manufacturer-sponsored programs, including: * Free goods (PAP) * Bridge / quick-start programs * Copay ...

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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.
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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, 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.

Associate Director - Field Reimbursement Manager, Oncology - Mid-Atlantic

Bayer

Arlington, VA • On-site

$162K - $243K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 9 days ago

Bayer rating

8.3

Company rating: 8.3 out of 10

Based on 70 frontline employees who took The Breakroom Quiz

25th of 86 rated pharmaceutical

Job description

At Bayer we're visionaries, driven to solve the world's toughest challenges and striving for a world where 'Health for all Hunger for none' is no longer a dream, but a real possibility. We're doing it with energy, curiosity and sheer dedication, always learning from unique perspectives of those around us, expanding our thinking, growing our capabilities and redefining 'impossible'. There are so many reasons to join us.

If you're hungry to build a varied and meaningful career in a community of brilliant and diverse minds to make a real difference, there's only one choice. Associate Director - Field Reimbursement Manager, Oncology - Mid-Atlantic Associate Director - Field Reimbursement Manager, Oncology - Mid-Atlantic Responsible for ensuring patient access to Bayer oncology products within assigned geographical area via supporting HCPs and Office staff in navigating therapy Prior Authorizations (PAs), Medical Necessity documentation and therapy PA denial appeals. Develop collaborative working partnerships with HCPs and Office Staff, to support Patient access to therapies.

This position works with medical practice therapy decision makers, practice clinical administrators, key office support staff and clinical pharmacists to assist with Health Plan/PBM therapy approval requests. This position is also responsible for collaboration with the Bayer Patient Support Services Team, Market Access Field Teams, Bayer AGMs, SCs and MSLs to execute reimbursement and access programs to reduce access and affordability hurdles for patients on Bayer oncology products. The span of coverage will be Mid-Atlantic which covers North Carolina, South Carolina, Washington DC & Virginia.

Travel up to 50% within the territory. The candidate must be domiciled within the territory. KEY TASKS AND RESPONSIBILITIES Extensive disease state/therapy space experience (specific to Bayer Programs/Therapies); Govt, National and local Commercial Payer experience, State Medicaid, and Managed Plans; Experience in educating and supporting Prior Authorization process, appeals, and denials; Covermymeds - portal access experience a plus; Proactive education - Access Services by Bayer; Stay current with local MAC policies and procedures; Excellent verbal and written communication skills as well as prior experience educating providers; Collaborating across multiple stakeholders; Proactive Problem solving, defusing, and resolving escalations, consistent and timely follow up; Proven experience in flexibility and adaptability Territory Management; Ability to engage and navigate HCPs in various settings including hospitals, private practice, large multi-specialty practices, IDNs, IDN out-patient clinics and other facilities; Initiative-taking business acumen to identify and resolve HCP/Office Staff issues/challenges with Payer/PBM therapy approvals; New Product / Indications launch experience; Must have a valid driver's license with a safe driving record/ MVR; Specialty Pharmacy Experience; Experience educating and/or supporting pharmacies.

WHO YOU ARE Bayer is seeking an incumbent who processes the following: REQUIRED QUALIFICATIONS Bachelor's Degree or minimum of 5 years' healthcare related reimbursement experience; 2 + years Field Reimbursement experience; In depth understanding of Payer/PBM therapy approval requirements (Prior Authorization, Medical Necessity, Denial Appeals, Formulary coverage and payment for oncology therapies across all sites of care (hospital, clinic, integrated delivery network) and ability to apply this knowledge to address individual customer concerns; Broad knowledge of Medicare, managed care, third party payers and Medicaid; Demonstrated excellence in meeting and exceeding customer expectations especially in demanding situations; Ability to effectively address customer concerns in a timely fashion and by working collaboratively with external and internal stakeholders; An elevated level of sophistication/people skills needed to interact with practice clinical decision makers, office support staff, clinical pharmacists, and office managers; Must demonstrate a comprehensive knowledge of customer relations, therapy formulary coverage, utilization management, and able to interpret complex information; Must possess the leadership ability to effectively organize, communicate and collaborate with HCPs, Key Practice Staff and Bayer external and internal team members; Exceptional knowledge of Healthcare Management; Pharmaceutical Manufacturer federal, state, and local compliance requirements; Area Reimbursement Managers will cover multiple regions, thus significant overnight travel, up to 50%; Must have a valid driver's license with a safe driving record/ MVR. PREFERRED QUALIFICATIONS 2 + years Oncology Field Reimbursement Experience; Experience in oncology and working with key oncology stakeholders. Employees can expect to be paid a salary between $162,000.00 - $243,000.00 Additional compensation may include a bonus or commission (if relevant)

Additional benefits include health care, vision, dental, retirement, PTO, sick leave, etc. This salary range is merely an estimate and may vary based on an applicant's location, market data/ranges, an applicant's skills and prior relevant experience, certain degrees and certifications, and other relevant factors. This posting will be available for application until at least 08/20/2026.

#LI #LI-AMS YOUR APPLICATION Bayer offers a wide variety of competitive compensation and benefits programs. If you meet the requirements of this unique opportunity, and want to impact our mission Health for all, Hunger for none, we encourage you to apply now. Be part of something bigger.

Be you. Be Bayer. To all recruitment agencies: Bayer does not accept unsolicited third party resumes.

Bayer is an Equal Opportunity Employer/Disabled/Veterans Bayer is committed to providing access and reasonable accommodations in its application process for individuals with disabilities and encourages applicants with disabilities to request any needed accommodation(s) using the contact information below. Equal Opportunity Employer Statement: Notice for U.S. Visitors: All information on this site is subject to compliance with local rule and regulations as they may vary from time to time and across different geographies, including, without limitation, U.S

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Bayer is a global enterprise with core competencies in the life science fields of healthcare and nutrition. We design our products and services to help people and planet thrive by supporting efforts to address the unprecedented global challenges presented by a growing and aging global population. At Bayer, we’re committed to drive sustainable development and generate a positive impact with our businesses. Through bold ideas and unprecedented insights, we’re pioneering new possibilities that advance life for all of us. That means reimagining how we care for ourselves and one another by empowering everyday health, improving approaches to patient care, and finding better ways to nourish our communities around the world.

Industry

Agriculture

Company size

10,000+ Employees

Headquarters location

Whippany, NJ, US

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