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Remote Optum Prior Authorization Jobs in Virginia

MCKESSON

Field Reimbursement Manager

Fairfax, VA · On-site +1

... Prior Authorization, Claims Assistance, and Appeals) and educating the office on Payer landscape and services available through both remote interaction and on-site training. This position is client ...

MCKESSON

Field Reimbursement Manager

Richmond, VA · On-site +1

... Prior Authorization, Claims Assistance, and Appeals) and educating the office on Payer landscape and services available through both remote interaction and on-site training. This position is client ...

MCKESSON

Field Reimbursement Manager

Alexandria, VA · On-site +1

... Prior Authorization, Claims Assistance, and Appeals) and educating the office on Payer landscape and services available through both remote interaction and on-site training. This position is client ...

MCKESSON

Field Reimbursement Manager

Arlington, VA · On-site +1

... Prior Authorization, Claims Assistance, and Appeals) and educating the office on Payer landscape and services available through both remote interaction and on-site training. This position is client ...

US Fertility, LLC

Financial Educator Remote

Annandale, VA · On-site +1

$23 - $27/hr

Opportunity Overview We have an immediate opening for an Financial Educator Remote to join our team ... Perform aspects of benefit verification and prior authorization * Provide ongoing financial ...

US Fertility

Financial Educator Remote

Annandale, VA · On-site +1

$23 - $27/hr

Opportunity Overview We have an immediate opening for an Financial Educator Remote to join our team ... Perform aspects of benefit verification and prior authorization * Provide ongoing financial ...

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 ...

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Remote Optum Prior Authorization information

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.

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 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.

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 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 74% Full Time, and 26% Part Time. Highlights an 100% Remote job distribution.

Reimbursement Specialist - Days - Remote

VCU Health

Richmond, VA • On-site, Remote

$19.87 - $30.79/hr

Full-time

Re-posted 16 days ago

VCU Health rating

7.3

Company rating: 7.3 out of 10

Based on 171 frontline employees who took The Breakroom Quiz

304th of 895 rated healthcare providers

Job description

***Must have BOTH a current VA Pharmacy and PTCB License***
The Reimbursement Specialist improves revenue collection pertaining to high cost medications that require prior authorization. This job will initiate, follow-up, and proceed with approval and/or denials of prior authorizations efficiently via phone, fax, or electronically.
The Reimbursement Specialist carries out benefit investigation and coordinates Patient Assistance Programs and/or copay cards for patients with high co-pays or those without insurance coverage. This role works closely with nursing and physicians in order to obtain required documentation for prior authorization and billing.
The Reimbursement Specialist arranges refills, transfers, and delivery of medications. Updates patient case management system regularly. Ideally, this role is familiar with disease state terminology or willingness to research. This role also works as a Pharmacy Technician when deemed necessary.
Licensure, Certification, or Registration Requirements for Hire:
Current certification by the Pharmacy Technician Certification Board (PTCB)
Current licensure with the Virginia State Board of Pharmacy
By virtue of societal trust and security explicitly imparted to pharmacies for the control of drugs, candidate/incumbent must have a clean criminal record (i.e. no felony conviction; no drug or pharmacy related convictions, including misdemeanors); no denial, suspension, revocation, or restriction of registration or licensure by any State Board of Pharmacy
Licensure, Certification, or Registration Requirements for continued employment:
Current certification by the Pharmacy Technician Certification Board (PTCB)
Current licensure with the Virginia State Board of Pharmacy
Experience REQUIRED:
Minimum of one (1) year of previous pharmacy practice experience in a similar setting
Minimum of three (3) years of prior experience with Manufacturers Patient Assistance Programs and prior experience with prescription on-line adjudication
Previous work experience using a personal computer and various billing software applications as well as e-mail, spreadsheets, word processing, databases, etc.
Experience PREFERRED: N/A
Education/training REQUIRED:
High School Diploma or equivalent
Education/training PREFERRED:
Associate's Degree in Business or related field from an accredited program
Independent action(s) required:
Identifies equipment problems; various aspects of assisting the pharmacist that don't require a pharmacist's supervision or check.
Supervisory responsibilities (if applicable): N/A
Additional position requirements:
Able to work all shifts, weekends, holidays, emergency coverage
Age Specific groups served: N/A
Physical Requirements (includes use of assistance devices as appropriate):
Physical: Lifting less than 20 lbs.
Activities: Prolonged standing, Prolonged sitting, Frequent bending, Walking (distance), Climbing (steps, ladder, other), Reaching (overhead, extensive, repetitive), Repetitive motion
Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking
Emotional: Fast pace environment, Steady pace, Able to handle multiple priorities, Frequent and intense customer interactions, Noisy environment, Able to adapt to frequent change
Compensation Range
$19.87 - $30.79
Actual salary offers will be based on several key factors to include relevant work experience, credentials, and qualifications.
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