Insurance Authorization Specialist Senior - Pre Service

Inova Health System; Virginia; Hybrid; USD 75,000 - 100,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Retirement match (5%)

Tuition and student loan assistance

Mental health support

Job summary

Inova Health System is seeking a dedicated Insurance Authorization Specialist Senior to join our team on a full-time, day-shift hybrid schedule (Mon–Fri 9:00 am–5:30 pm) in Virginia. The role leads complex authorization workflows, collaborates with physicians and care teams, supports payer requirements, and helps prevent denials while improving financial clearance and patient experience.

Candidates should have 4 years in healthcare revenue cycle, strong attention to detail, and Epic scheduling

Qualifications

• 4 years in healthcare revenue cycle or preservice clearance.

Responsibilities

• Acts as SME for complex authorization workflows across specialty lines.
• Manages high-complexity authorization cases including advanced procedures and high-acuity programs.
• Interprets payer policies to prevent denials and handle escalations.
• Coordinates peer-to-peer reviews, payer escalations, and complex authorization resolutions.
• Collaborates with physicians, clinical teams, schedulers, and leadership to ensure medical necessity.
• Supports denial prevention by identifying authorization risks and policy gaps.
• Reviews insurance coverage and financial clearance requirements to mitigate revenue risk.
• Maintains expert knowledge of payer requirements and specialty service-line policies.
• Performs additional duties as assigned.

Skills

Bilingual Spanish

Multitasking

Attention to detail

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 |

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