Insurance Authorization Specialist - Pre Service

Inova Health System; Fairfax (VA); Hybrid; USD 42,000 - 54,000; Full time

Job summary

Inova Health System in Virginia is seeking an Insurance Authorization Specialist to join our team as a full-time, hybrid-role after an initial on-site training period. The position focuses on preservice financial clearance for moderate to complex services and requires coordination with clinics and schedulers.

The role emphasizes review of payer policies, documentation standards, and proactive follow-up with payers to secure timely approvals.

Qualifications

• 2 years of healthcare revenue cycle, patient access, or related operations
• Experience with authorization processes and preservice clearance
• Knowledge of payer policies and medical necessity criteria

Responsibilities

• Independently manages authorization and preservice financial clearance activities for moderate to complex specialty services, including surgeries, procedures, rehabilitation services, neurology services, recurring department services, and specialty clinic treatments.
• Performs detailed review of payer medical policies, insurance coverage requirements, and medical necessity criteria to ensure appropriate authorization submission and denial prevention.
• Coordinates closely with clinical schedulers, clinics, and operational teams to ensure service-line–specific authorization requirements and documentation standards are met.
• Manages authorization requests through payer portals and electronic workflows while proactively monitoring status and performing follow-up with insurance payers to facilitate timely approvals.
• Maintains a strong working knowledge of payer policies, insurance plans, and specialty service-line authorization requirements.
• Collaborates with operational teams to support workflow improvements related to authorization processing, preservice financial clearance, and patient access operations.
• May perform additional duties as assigned.

Skills

Analytical skills

Problem-solving

Customer service

Education

High school or GED

Job description

Insurance Authorization Specialist - Pre Service

VA, United States

Job Description

Inova is looking for a dedicated Insurance Authorization Specialist to join the team. This role will be Full-Time Shift = 9:30am - 6:00pm M-F/ Hybrid following initial 90-days on-site training.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.

Retirement:Inova matches the first 5% of eligible contributions – starting on your first day.

Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.

Mental Health Support:offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.

• Independently manages authorization and preservice financial clearance activities for moderate to complex specialty services, including surgeries, procedures, rehabilitation services, neurology services, recurring department services, and specialty clinic treatments.
• Performs detailed review of payer medical policies, insurance coverage requirements, and medical necessity criteria to ensure appropriate authorization submission and denial prevention.
• Coordinates closely with clinical schedulers, clinics, and operational teams to ensure service-line–specific authorization requirements and documentation standards are met.
• Manages authorization requests through payer portals and electronic workflows while proactively monitoring status and performing follow-up with insurance payers to facilitate timely approvals.
• Maintains a strong working knowledge of payer policies, insurance plans, and specialty service-line authorization requirements.
• Collaborates with operational teams to support workflow improvements related to authorization processing, preservice financial clearance, and patient access operations.
• May perform additional duties as assigned.

Additional Requirements

• Experience - 2 years of healthcare revenue cycle, patient access, authorizations, preservice financial clearance, or related healthcare operations
• Education - High school or GED

Preferred Candidate Profile

• Strong background in healthcare authorization, patient access, revenue cycle, or preservice financial clearance.
• Experience working with complex specialty services and payer authorization requirements.
• Knowledge of insurance eligibility, benefits verification, medical necessity guidelines, and financial counseling.
• Strong analytical, problem-solving, and customer service skills.
• Ability to work independently, manage multiple priorities, and thrive in a fast-paced healthcare environment.

About Us

We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare.

Inova Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.