Insurance Authorization Specialist Senior - Pre Service

Inova Health System; Fairfax, Northern (VA, KY); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Retirement match 5%

Tuition and Loan Assistance

Mental Health Support

Job summary

Inova Health System is seeking a Senior Insurance Authorization Specialist to join our team in a full-time, day-shift role. This hybrid position supports patients across multiple service lines and requires meticulous review of complex payer requirements to prevent denials.

You will collaborate with clinicians, schedulers, and revenue-cycle leaders to ensure timely and accurate pre-authorizations. Qualified candidates will have at least four years in healthcare revenue cycle, preservice

Qualifications

• 4 years of healthcare revenue cycle, patient access, authorizations, preservice financial clearance, or related healthcare operations.
• High school diploma or GED is required.
• Bilingual Spanish is a plus.

Responsibilities

• Serve as subject matter expert for complex authorization and preservice financial clearance workflows across multiple service lines.
• Manage high-complexity authorization cases including advanced procedural services and high-acuity programs.
• Interpret payer policies to ensure compliance and prevent denial, including escalations and non-standard pathways.
• Coordinate peer-to-peer reviews, payer escalations, and complex authorization resolutions when clinical review is required.
• Collaborate with physicians, clinical teams, schedulers, and leadership to meet medical necessity and documentation requirements.
• Support denial prevention and revenue risk mitigation through proactive risk identification.

Skills

Healthcare revenue cycle

Authorization workflows

Payer policy interpretation

Communication

HIPAA compliance

Education

High school diploma or GED

Tools

Epic scheduling

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 |

I nova 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 fast‑paced environment.
• Strong attention to detail and commitment to patient confidentiality and HIPAA compliance.