Insurance Authorization Specialist Senior - Pre Service

Inova Health System; Falls Church (VA); Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement: 5% company match

Education assistance up to $5,250/year

Student loan assistance up to $10,000

Mental health coaching/therapy

Job summary

Inova Health System is seeking an Insurance Authorization Specialist Senior to join our team in Falls Church, VA. This full-time role supports complex medical authorizations and preservice financial clearance within a hybrid work model, Monday–Friday, 9:00 a.m.–5:30 p.m.

You will collaborate with physicians, clinical teams, and payers to ensure timely, accurate medical necessity determinations and to mitigate denials. Strong communication and Epic scheduling experience are valued.

Qualifications

• Minimum 4 years in healthcare revenue cycle or authorizations.
• High school diploma or GED required.
• Bilingual Spanish preferred.

Responsibilities

• Serve as subject matter expert for complex authorization workflows across multiple service lines.
• Manage high-complexity authorization cases including advanced procedures.
• Interpret payer policies to ensure compliance and prevent denials.
• Coordinate peer-to-peer reviews and payer escalations.
• Collaborate with physicians and teams to ensure medical necessity before service.
• Support denial prevention and financial readiness by reviewing coverage.
• Review and resolve complex estimate scenarios and improve accuracy.
• Maintain expert knowledge of payer requirements and service-line policies.
• Perform additional duties as assigned.

Skills

Healthcare revenue cycle

Authorization workflows

Patient access

Attention to detail

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 |

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.