Top 45 Prior authorization specialist Jobs in Fulton, Md

Referral Authorization Specialist
Samaritan —Washington, DC
- $21.24 - $28.84 an hour
- Full-time
- Remote
- Heavy lifting
- HIPAA
- Mid-level
Quick Apply
Scheduler & Authorization Specialist
OrthoMaryland —Baltimore, MD
- Remote
- English
- Mid-level
- High school diploma or GED
Quick Apply
9d
Benefits & Auth for Physical Therapy
RSI-Rehabilitation Services, Inc. —Laurel, MD
- $23 - $29 an hour
- Full-time
- HIPAA
- Mid-level
- In-person
- Disability insurance
- Health insurance
Quick Apply
8d
Insurance Verification & Authorization Specialist
The Centers for Advanced Orthopaedics LL —Columbia, MD
- Medical office experience
- English
- Mid-level
Quick Apply
Prior Authorization Certified Pharmacy Technician
Shields Health Solutions —Baltimore, MD
- $19.45 - $22.21 an hour
- Remote
- Microsoft Excel
- Microsoft Outlook
- Research
Quick Apply
Medication Access Coordinator II
Johns Hopkins Care at Home —Baltimore, MD
- $20.53 - $33.90 an hour
- Full-time
- Hybrid work
- Mid-level
- High school diploma or GED
- 2 years
- Health insurance
- Dental insurance
8d
Pre-Registration Specialist, Per Diem
Samaritan —Washington, DC
- $21.10 - $26.26 an hour
- Part-time
- Remote
- Mid-level
- High school diploma or GED
- Mentoring
Quick Apply
ADMISSIONS AUTHORIZATION SPECIALIST
MT WASHINGTON PEDIATRIC HOSPITAL —Baltimore, MD
- $18.74 - $23.42 an hour
- Full-time
- Writing skills
- Data analysis skills
- High school diploma or GED
Quick Apply
8d
Scheduler & Authorization Specialist
The Centers for Advanced Orthopaedics LL —Chevy Chase, MD
- $21 an hour
- English
- Mid-level
- High school diploma or GED
Quick Apply
Referral Coordinator
Chase Brexton Health Care —Columbia, MD
- $19.50 - $22.13 an hour
- Full-time
- Medical office experience
- HIPAA
- High school diploma or GED
Quick Apply
Part-Time Prior Authorization Specialist
Endo Kids Concierge —Vienna, VA
- From $25 an hour
- Part-time
- Hybrid work
- Mid-level
- Children
- Pediatrics
Quick Apply
6d
Coordinator - Prior Authorization Verification and Eligibility
Luminis Health —Annapolis, MD
- $17.50 - $26.00 an hour
- Full-time
- Microsoft Outlook
- Hospital
- Medical office experience
- AD&D insurance
- Paid holidays
Surgical Scheduler/Authorization Specialist
Reconstructive Surgery —Falls Church, VA
- Full-time
- Bilingual
- Background check
- Surgery
- Health insurance
- Dental insurance
Quick Apply
8d
Prior Authorization Representative
Clinical Associates, P.A. —Towson, MD
- Full-time
- Medical office experience
- English
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Payor Clearance Specialist
Children's National Hospital —Silver Spring, MD
- $48,672 - $81,120 a year
- Full-time
- Bilingual
- Mid-level
- 3 years
- Commuter assistance
- AD&D insurance
Coordination Specialist
Peraton —Annapolis Junction, MD
- $112,000 - $179,000 a year
- Bachelor of Science
- 11+ years
- Bachelor's degree
- Health savings account
- Paid holidays
Senior Financial Clearance Specialist, Day
University of Maryland Medical System —Linthicum Heights, MD
- Full-time
- Medical office experience
- Mid-level
- Epic
8d
Sr. Medical Office Coordinator (Orthopaedic Surgery)
Johns Hopkins University —Columbia, MD
- $18.20 - $33.90 an hour
- Full-time
- Background check
- Surgery
- Mid-level
2d
Prof Fee AR Specialist CBO, FT Hybrid
University of Maryland Medical System —Linthicum Heights, MD
- Full-time
- Word processing
- Basic math
- Research
Billing Support Specialist I
GeneDx —Gaithersburg, MD
- $23.50 - $25.50 an hour
- Bilingual
- Writing skills
- Office
1d

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Referral Authorization Specialist

Samaritan -
Washington, DC

Quick Apply

Job Details

Full-time
$21.24 - $28.84 an hour

Qualifications

Customer communication
High school diploma or GED

Full Job Description

Our Mission

All of us, for each of you, every time.

Our Vision

Together, serving as the trusted regional healthcare partner.

Our Values

Listen~Love~Respect~Excel~Innovate

Samaritan is searching for a Referral & Authorization Specialist to join our team! The Referral & Authorization Specialist is responsible for coordinating and securing prior authorizations, managing outgoing referrals, and ensuring compliance with payer requirements to support timely patient care and optimal reimbursement. This role serves as a critical liaison between providers, patients, payers, and internal departments to reduce denials, prevent delays in care, and ensure accurate documentation.

This is a full-time remote position that will be required to come on-site for onboarding and equipment pick-up (2 DAYS ONLY). This is a full-time role working Monday-Friday from 8:00 AM – 4:30 PM PST.

ESSENTIAL FUNCTIONS

Prior Authorization Management

Obtain prior authorizations for hospital and clinic services, including but not limited to, outpatient procedures, imaging, surgeries, and other specialty services.

Identify the health plan(s) by confirming information provided and verifying eligibility and coverage.

Verify payer requirements for authorization, referral, and medical necessity requirements based on plan guidelines.

Submit complete and accurate authorization requests with appropriate clinical documentation.

Track authorization status and follow up with the payer at regular intervals to ensure timely approvals.

Escalate urgent or complex cases to avoid delays in patient care.

Document authorization numbers, effective dates, and limitations in the EMR.

Communicate authorization delays and denials to ordering providers and clinics.

Monitor authorization workqueues and ensure timely completion.

Referral Management

Coordinate with providers and clinics to ensure appropriate scheduling and continuity of care.

Process outgoing referrals for specialty care.

Ensure referrals meet payer and regulatory requirements (e.g., PCP referrals, network rules).

Monitor referral workqueues and ensure timely completion.

Denial Prevention & Revenue Cycle Support

Review payer policies to ensure compliance and minimize denials.

Partner with coding, billing, and clinical teams to resolve authorization-related denials.

Inform department professionals and/or providers when peer-to-peer review is necessary. Assist as needed.

Assist with retro authorization requests and appeals as needed.

Identify trends and recommend process improvements.

Communication & Assistance

Serve as the point of contact for patients regarding referral and authorization status.

Communicate clearly with providers, clinical staff, payers, and patients.

Educate patients on authorization and referral procedures and next steps.

Maintain ongoing tracking and documentation for prior authorizations and referrals to promote team awareness.

Ensure HIPAA compliance when sharing patient information with authorized care providers.

General

Participate in continuing education opportunities.

Maintains professional growth and development through seminars, workshops and professional affiliations to keep abreast of latest trends in the field of expertise.

Ensures no injuries to self or others by following safe work practices and policies. This includes, but is not limited to: security and safety, understanding of chemical Safety Data Sheets (SDS), equipment, infection control, fire, disaster, safe lifting and body mechanics.

Ensures self-compliance with organization policies and procedures, as well as labor agreements.

Ensures the interface with team members and other support groups is conducted in a courteous and efficient manner conducive to the organization's values.

Conducts self in a professional manner and ensures personal appearance meets the standards necessary to perform the job function while representing the organization.

Ensures that additional accountabilities, as may be required by management, be handled in a manner necessary to meet organizational standards.

WORK ENVIRONMENT

The professional in this position reports to the Director of Revenue Cycle. Professionals in this position will work closely with patients and other Samaritan professionals within various departments.

EDUCATION & EXPERIENCE

Education:
- High school diploma or equivalent required; Associate degree preferred.
Experience:
- Minimum of two (2) years of experience in healthcare referrals, prior authorizations, or revenue cycle required.
- Experience working in a healthcare setting providing multi-specialty support preferred.
- Certified Healthcare Access Associate (CHAA) or similar certification preferred.
- Experience with Medicare, Medicaid (including Washington Apple Health), and commercial payers.
- Understanding of medical necessity criteria and utilization management.
Skills/Competencies:
- Strong knowledge of insurance plans, payer requirements, and authorization requirements.
- Familiarity with CPT, IDC-10, and medical terminology.
- Experience with EMR systems (EPIC) and payer portals (e.g., Availity, OneHealthPort, payer websites)
- Excellent organizational and time management skills.
- Ability to manage high-volume workqueues with attention to detail.
- Effective communication and interpersonal skills.
- Demonstrates competency on equipment listed on department specific checklist.
- Strong critical thinking skills: seeks resources for direction, when necessary. Performs independent problem solving. Decision-making is logical and deliberate.
- Performs actions that demonstrate accountability. Exercises safe judgment in decision-making. Practices within legal and ethical guidelines.
- Demonstrates competency in ability to care for customers/patients across the age continuum.

PHYSICAL REQUIREMENTS

Occasional lifting, reaching, kneeling, bending, stooping, pushing and pulling.

Occasional heavy lifting (lift/carry up to 50 lbs.).

Manual dexterity and mobility.

Ability to read and understand patient charts, provider orders, tests results, etc.

Ability to communicate using verbal and/or written skills for accurate exchange of information with physicians, nurses, health care professionals, patients and/or family, and the public.

As a Samaritan professional, you will be asked to carry out the Mission, Vision, Values, and Strategy of Samaritan, personifying service and operational excellence including the creation and maintenance of the best patient, professional, physician, and student experience.

Experience

Required

2 year(s): Experience in healthcare referrals, prior authorizations, or revenue cycle

Preferred

Experience with Medicare, Medicaid (including Washington Apple Health), and commercial payers.
Experience working in a healthcare setting providing multi-specialty support

Education

Required

High School or better

Preferred

Associates or better

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Quick Apply

Refine Your Search

prior authorization specialist jobs in fulton, md

Referral Authorization Specialist

Scheduler & Authorization Specialist

Benefits & Auth for Physical Therapy

Insurance Verification & Authorization Specialist

Prior Authorization Certified Pharmacy Technician

Medication Access Coordinator II

Pre-Registration Specialist, Per Diem

ADMISSIONS AUTHORIZATION SPECIALIST

Scheduler & Authorization Specialist

Referral Coordinator

Part-Time Prior Authorization Specialist

Coordinator - Prior Authorization Verification and Eligibility

Surgical Scheduler/Authorization Specialist

Prior Authorization Representative

Payor Clearance Specialist

Coordination Specialist

Senior Financial Clearance Specialist, Day

Sr. Medical Office Coordinator (Orthopaedic Surgery)

Prof Fee AR Specialist CBO, FT Hybrid

Billing Support Specialist I

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