Senior Insurance Authorization Specialist

Inova Fairfax Hospitall is looking for a dedicated Insurance Authorization Specialist Senior to join the team. This role will be Hybrid FT 8a-5:30p w/ rotating Saturday and rotating holidays

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.
• Work/Life Balance:offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities. (only include "remote and hybrid career opportunities" if your position is eligible for remote/hybrid options).

Insurance Authorization Specialist Senior 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.

Minimum Qualifications:

High School or GED

4 years Healthcare revenue cycle, patient access, authorizations, preservice financial clearance, or related healthcare operations