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Remote Optum Prior Authorization Jobs in Virginia

Premise Health

Medical Assistant (Remote)

Richmond, VA · On-site +1

$19 - $27.50/hr

As a Part Time Medical Assistant (Remote), you'll provide care to client employees in our Health ... prior authorizations, coordinate any necessary testing and lab work, and ensure all aspects of ...

ICF

Salesforce PSS Developer DHS (Remote)

Reston, VA · Remote

$57.75 - $76.50/hr

Remote work is authorized. Must supportUS Eastern time zoneworking hours. What You Will Do ... Prior experienceperformingDevOpsactivitiesincluding package creation & deployment,code scan ...

Oran, Inc.

GIS Developer-USDA

Herndon, VA · On-site +1

$118K/yr

Remote (U.S.) Employment Type: Full-Time Salary: Up to $118,000/year Work Authorization: U.S ... Prior USDA project experience is mandatory * Bachelor's degree in Computer Science, Information ...

Oran Inc

GIS Developer-USDA

Herndon, VA · Remote

$118K/yr

Remote (U.S.) Employment Type: Full-Time Salary: Up to $118,000/year Work Authorization: U.S ... Prior USDA project experience is mandatory * Bachelor's degree in Computer Science, Information ...

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All JobsOptum Prior Authorization JobsRemote Optum Prior Authorization JobsRemote Optum Prior Authorization Jobs in Virginia

Remote Optum Prior Authorization information

What is the difference between Remote Optum Prior Authorization vs Remote Optum Claims Reviewer?

AspectRemote Optum Prior AuthorizationRemote Optum Claims Reviewer
CredentialsTypically requires healthcare-related certifications, such as RN, LPN, or medical coding credentialsOften requires similar healthcare certifications, with focus on claims processing
Work EnvironmentRemote, healthcare insurance setting, interacting with providers and patientsRemote, insurance claims processing environment, reviewing submitted claims
Employer & Industry UsageCommonly employed by health insurance companies like Optum, focusing on authorization processesEmployed by insurance companies, focusing on claims review and reimbursement

Remote Optum Prior Authorization specialists focus on obtaining approvals for healthcare services, while Remote Optum Claims Reviewers evaluate submitted claims for accuracy and reimbursement. Both roles require healthcare knowledge and certifications, but differ in their primary functions within the insurance process.

What is a Remote Optum Prior Authorization?

A Remote Optum Prior Authorization job involves reviewing and processing requests from healthcare providers to determine whether certain medical procedures, medications, or services will be covered under a patient's insurance plan. Employees in this role work from home and use clinical guidelines to assess the necessity and appropriateness of requested treatments. They collaborate with providers, patients, and insurance teams to ensure timely authorization decisions. This position typically requires strong communication skills, attention to detail, and familiarity with healthcare regulations and insurance policies.

What are the key skills and qualifications needed to thrive as a Remote Optum Prior Authorization specialist, and why are they important?

To thrive as a Remote Optum Prior Authorization Specialist, you need strong knowledge of medical terminology, insurance processes, and prior authorization protocols, typically supported by a healthcare-related degree or relevant experience. Familiarity with electronic health record (EHR) systems, insurance verification tools, and prior authorization software is essential. Excellent attention to detail, organizational skills, and effective communication are vital soft skills for efficiently managing high volumes of authorization requests and collaborating with providers. These skills ensure accurate, timely approvals and help optimize patient care while reducing administrative delays.

How does a Remote Optum Prior Authorization specialist typically interact with healthcare providers and insurance teams?

As a Remote Optum Prior Authorization specialist, you will regularly communicate with healthcare providers, pharmacies, and insurance representatives to obtain and verify necessary information for authorizing medical procedures or medications. Most interactions occur via phone, secure messaging, or electronic health record systems, requiring clear communication and attention to detail. Collaboration is essential, as you'll often need to clarify clinical documentation with providers and ensure compliance with insurance guidelines. This role is well-suited for those who are organized, proactive, and comfortable working independently within a supportive virtual team environment.
What are popular job titles related to Remote Optum Prior Authorization jobs in Virginia? For Remote Optum Prior Authorization jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Remote Optum Prior Authorization jobs in Virginia look for? The top searched job categories for Remote Optum Prior Authorization jobs in Virginia are:
What cities in Virginia are hiring for Remote Optum Prior Authorization jobs? Cities in Virginia with the most Remote Optum Prior Authorization job openings:
Remote Optum Prior Authorization jobs near you
Infographic showing various Remote Optum Prior Authorization job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, 1% Temporary, and 3% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

Reimbursement Specialist Supervisor - Remote

VCU Health

Richmond, VA • On-site, Remote

$19 - $26.25/hr

Full-time

This job post has expired today. Applications are no longer accepted.

VCU Health rating

7.3

Company rating: 7.3 out of 10

Based on 171 frontline employees who took The Breakroom Quiz

304th of 887 rated healthcare providers

Job description

**Remote to Virginia ONLY! Must have active VA Pharmacy and PTCB license in good standing**
The Reimbursement Specialist Supervisor oversees the daily operations of the Reimbursement Specialist team to ensure timely and accurate processing of prior authorizations, insurance follow-ups, and patient assistance program requests pertaining to high-cost medications that require prior authorization. This role provides guidance, coaching, and performance management for team members, while supporting workflow optimization and departmental revenue collection goals.
Essential Job Statements
  • Supervise, coordinate, and prioritize the workflow of Reimbursement Specialists across multiple clinics.
  • Provide direct line supervision for Reimbursement Specialists, including performance evaluations, disciplinary action, time/attendance, coordination of staff activities, or other work as needed. Conduct hiring, interviewing, onboarding, and training of new employees.
  • Monitor team productivity and compliance with turnaround times, providing feedback and coaching as needed.
  • Facilitate training and onboarding of new Reimbursement Specialists.
  • Review complex or escalated prior authorizations and appeals, ensuring appropriate documentation and
  • compliance with insurance and regulatory requirements.
  • Collaborate with providers, nursing staff, and the Patient Assistance Program (PAP) team to ensure patients receive timely access to medications.
  • Identify process improvements to optimize team efficiency and patient care outcomes.
  • Prepare and review reports on team performance, Patient Assistance (PA) approvals/denials, and workload metrics.
  • Ensure compliance with departmental and health system policies and regulatory requirements.
  • Participate in special projects and cross-functional initiatives as assigned.
  • Serve as a point of contact for internal and external escalations related to PAs, appeals, or patient access concerns.
  • Performs other duties as assigned and/or participates in special projects to support the mission of VCUHS and the Department. Provides assistance to team members. Accepts alternate assignments, as required.

Patient Population
Not applicable to this position.
Employment Qualifications
Required Education:
High School Diploma or equivalent
Preferred Education:
Associate's Degree or higher in Business, Healthcare Administration, or related field
Licensure/Certification Required:
Current certification by the Pharmacy Technician Certification Board (PTCB) Current licensure with the Virginia State Board of Pharmacy
Licensure/Certification Preferred:
Additional supervisory or leadership certifications a plus
Minimum Qualifications
Years and Type of Required Experience •
Minimum of three (3) years of experience as a Reimbursement Specialist or equivalent role
Previous experience supervising or mentoring staff
Other Knowledge, Skills and Abilities Required:
Strong knowledge of PAPs, prior authorizations, and insurance benefit investigations
Proficiency in EMR systems and Microsoft Office
Cultural Responsiveness
Other Knowledge, Skills and Abilities Preferred:
Strong leadership and communication skills
Ability to handle multiple priorities and high-volume workload
Working Conditions
Periods of high stress and fluctuating workloads may occur.
General office environment.
May be exposed to high noise levels and bright lights.
May have periods of constant interruptions.
Prolonged periods of working alone.
Physical Requirements
Physical Demands: Lifting/ Carrying (0-50 lbs.), Bending
Work Position: Sitting, Walking, Standing
Additional Physical Requirements/ Hazards
Physical Requirements: Manual dexterity (eye/hand coordination), Perform shift work, Hear alarms/telephone/tape recorder, Reach above shoulder, Repetitive arm/hand movements, Finger Dexterity, Color Vision, Acuity - far, Acuity - near
Hazards:
Mental/Sensory - Emotional
Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking
Emotional: Fast-paced environment, Steady Pace, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Noisy Environment, Able to Adapt to Frequent Change
EEO Employer/Disabled/Protected Veteran

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