Insurance Authorization Specialist Senior

Inova Health System; Falls Church (VA); Hybrid; USD 60,000 - 76,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement match 5%

Education assistance (up to $5,250/yr)

Student loan assistance (up to $10,000

Mental health support (25 sessions/yr)

Job summary

Inova Health System is seeking a dedicated Insurance Authorization Specialist Senior for a full-time hybrid role in Falls Church, VA. The position supports complex authorizations across multiple service lines with a focus on reducing denials and ensuring medical necessity prior to services.

You will collaborate with clinicians, schedulers, and leadership, handling advanced payer policies and escalations while supporting a patient-centered revenue cycle workflow.

Qualifications

• Experience - 4 years of healthcare revenue cycle, patient access, authorizations, preservice financial clearance, or related healthcare operations
• Education - High school diploma or GED

Responsibilities

• Serves as a subject matter expert for complex authorization and preservice financial clearance workflows across multiple specialty service lines
• Manages high-complexity authorization cases including advanced procedural services, radiation oncology, infusion services, and other high-acuity specialty programs
• Performs advanced payer medical policy interpretation to ensure compliance with payer authorization requirements and prevent denial
• Coordinates peer-to-peer reviews, payer escalations, and complex authorization resolution activities when clinical review is required
• Collaborates with physicians, clinical teams, schedulers, and operational leadership to ensure documentation and medical necessity requirements are met prior to service
• Supports denial prevention strategies by proactively identifying authorization and medical policy risks that may impact reimbursement
• Provides advanced financial readiness support by reviewing insurance coverage and verifying clearance requirements
• Reviews and resolves complex estimate scenarios while identifying opportunities to improve estimate accuracy and automation
• Maintains expert-level knowledge of payer authorization requirements, insurance plans, and specialty service-line policies

Job description

Inova is looking for a dedicated Insurance Authorization Specialist Senior to join the team. This role will be Full-time Day Shift: Monday - Friday, 9:00 a.m. - 5:30 p.m. | Hybrid Position |

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.

Featured Benefits:

• 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.

Job Responsibilities

• Serves as a subject matter expert for complex authorization and preservice financial clearance workflows across multiple specialty service lines.
• Manages high-complexity authorization cases including advanced procedural services, radiation oncology, infusion services, and other high-acuity specialty programs.
• Performs advanced payer medical policy interpretation to ensure compliance with payer authorization requirements and prevent denial, including handling complex payer scenarios, including escalations, specialty program requirements, and non-standard authorization pathways.
• Coordinates peer-to-peer reviews, payer escalations, and complex authorization resolution activities when clinical review is required.
• Collaborates closely with physicians, clinical teams, schedulers, and operational leadership to ensure clinical documentation and medical necessity requirements are met prior to service.
• Supports denial prevention strategies by proactively identifying authorization and medical policy risks that may impact reimbursement.
• Provides advanced financial readiness support by reviewing insurance coverage, verifying financial clearance requirements, and supporting revenue risk mitigation.
• Reviews and resolves complex estimate scenarios while identifying opportunities to improve estimate accuracy and automation.
• Maintains expert-level knowledge of payer authorization requirements, insurance plans, and specialty service-line policies.
• May perform additional duties as assigned.

Additional Requirements

• Experience - 4 years of healthcare revenue cycle, patient access, authorizations, preservice financial clearance, or related healthcare operations
• Education - High school diploma or GED

Preferred Qualifications

• Bilingual proficiency (Spanish) to support a diverse patient population
• Experience working with Primary Care, including scheduling, authorizations, or specialty workflows
• Prior patient scheduling experience in a healthcare, clinic, or hospital setting.
• Experience providing telephonic support to patients, including handling high call volumes and navigating sensitive conversations.
• Proficiency with Epic (EPIC) scheduling modules, including appointment scheduling, registration updates, and navigation of patient records.
• Ability to multitask, manage competing priorities, and maintain accuracy in a fastpaced environment.
• Strong attention to detail and commitment to patient confidentiality and HIPAA compliance.