Top 90 Insurance verification Jobs in Richmond, Va

Clinical Authorization Specialist (Utilization Review)
HALLMARK YOUTHCARE RICHMOND INC —Richmond, VA
- $27 - $31 an hour
- Monday to Friday
- Mid-level
- Residential
- Master's degree
- Health insurance
- 401(k) matching
Quick Apply
12d
Insurance Specialist - Home Care
Care Advantage Inc. Corporate —Richmond, VA
- Full-time
- Hybrid work
- Mid-level
- Administrative experience
- High school diploma or GED
- Disability insurance
- Health insurance
Quick Apply
12d
Front Desk Representative
VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER —Richmond, VA
- $19.75 - $30.90 an hour
- Extended hours
- Spanish
- English
- High school diploma or GED
- AD&D insurance
- Paid holidays
Quick Apply
Care Coordination Assistant – Nursing Facility Attending Service
VCU Health System —Richmond, VA
- Part-time
- Microsoft Excel
- Skilled nursing facility
- Inventory management
5d
Leave Specialist - REMOTE
Ryder System —Richmond, VA
- $55,000 a year
- Full-time
- Remote
- Microsoft Excel
- Mid-level
- Analysis skills
- Disability insurance
- Health insurance
Patient Registrar Weekdays
Henrico Doctors' Hospital Forest —Richmond, VA
- $15.00 - $21.44 an hour
- Full-time
- Entry level
- Employee stock purchase plan
- Disability insurance
Quick Apply
2d
Telehealth Coordinator Lead
CorVel Corporation —Glen Allen, VA
- $19.24 - $31.04 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
Home Health Intake Lead
Home Recovery Home Aid —Richmond, VA
- Full-time
- Remote
- Mid-level
- High school diploma or GED
- Supervising experience
Outpatient Rehab Scheduler – Memorial Regional Medical Center Cardiopulmonary Rehabilitation
Bon Secours —Mechanicsville, VA
- $19.03 - $28.54 an hour
- Hospital
- Mid-level
- Office
- Health savings account
- Disability insurance
Patient Services Representative – Care-A-Van
Bon Secours —Richmond, VA
- $16.76 - $24.65 an hour
- High school diploma or GED
- Children
- Computer skills
- Health savings account
- Disability insurance
Medical Office Representative - Oncology Clinic - Days
VCU Health System —Richmond, VA
- Full-time
- Microsoft Word
- Windows
- High school diploma or GED
Patient Care Coordinator
Physical Therapy Solutions —Mechanicsville, VA
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
9d
Patient Care Representative
Virginia Eye Institute —Richmond, VA
- $18.00 - $22.98 an hour
- Full-time
- High school diploma or GED
- Clinic
- Typing
- COVID-19 protective measures
Quick Apply
2d
Imaging Center Front Desk Registrar - Weekend Hours
MEDRVA Healthcare —Henrico, VA
- Full-time
- Microsoft Excel
- HIPAA
- High school diploma or GED
Quick Apply
2d
Front Desk Coordinator Surgery Center
Fresenius Medical Care —Richmond, VA
- Full-time
- High school diploma or GED
- Perioperative Care
- Data entry
Patient Care Coordinator II
Phoenix Physical Therapy —Richmond, VA
- Part-time
- Microsoft Word
- CPR Certification
- BLS Certification
- Gym membership
Quick Apply
Home Health Intake Lead
CareRing Health, LLC —Richmond, VA
- Full-time
- Mid-level
- High school diploma or GED
- Supervising experience
Scheduling Specialist - Tuckahoe Orthopaedic & Physical Therapy
Bon Secours —Richmond, VA
- $17.25 - $25.87 an hour
- Mid-level
- High school diploma or GED
- Children
- Health savings account
- Disability insurance
Patient Logistic Specialist
HCA Healthcare —Richmond, VA
- $17.36 - $26.05 an hour
- 12 hour shift
- Mid-level
- Organizational skills
- Communication skills
- Employee stock purchase plan
- Disability insurance
Quick Apply
2d
Revenue Cycle & Patient Access Manager
MEDRVA Healthcare —Richmond, VA
- $85,000 - $105,000 a year
- Finance
- Supervising experience
- Bachelor's degree
Quick Apply

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Clinical Authorization Specialist (Utilization Review)

HALLMARK YOUTHCARE RICHMOND INC -
Richmond, VA

Quick Apply

Job Details

$27 - $31 an hour
12 days ago

Benefits

Health insurance
401(k) matching

Qualifications

Medicare
Commercial insurance knowledge
Electronic health records (EHR) management
Medical insurance coverage verification
High school diploma or GED
Clinical case management
Medicaid health insurance
Pre-authorization review for utilization management
Medicare regulations
Utilization management
Resource utilization in healthcare
Medicaid regulations
Medicaid

Full Job Description

As a leading Residential Treatment Center in the Greater Richmond area, Hallmark Youthcare treats adolescents with emotional and behavioral challenges triggered by trauma. Treatment is provided in a warm and friendly environment by a group of well-trained, highly motivated staff that take pride in delivering quality care in a fast-paced environment.

We are seeking a detail-oriented Clinical Authorization Specialist (Utilization Review) to join our healthcare team. The ideal candidate will have experience in prior authorizations, insurance verification, utilization review, and medical necessity determinations. This role is responsible for ensuring that medical services are appropriately authorized, clinically supported, and compliant with payer guidelines before, during, and after patient care.

The Clinical Authorization Specialist serves as a liaison between healthcare providers, insurance companies, and patients to facilitate timely approvals while minimizing denials and delays in care.

In addition, this role maintains communication with referral sources (CSA/FAPT/IACCT) to coordinate placement and reimbursement standards for transfers from emergency placements and document submission to Magellan for Medicaid consideration.

Key Responsibilities

Master's degree in health services field.
Review and process prior authorization requests for medical procedures, diagnostic testing, medications, therapies, and specialty services.
Evaluate clinical documentation to determine medical necessity using payer guidelines, evidence-based criteria, and insurance policies.
Perform prospective, concurrent, and retrospective utilization reviews.
Communicate with physicians, nurses, case managers, and insurance representatives to obtain required clinical documentation.
Submit authorization requests and monitor status through payer portals and electronic health record (EHR/EMR) systems.
Track authorization approvals, denials, appeals, and expiration dates to ensure continuity of care.
Identify incomplete or missing documentation and coordinate with providers to obtain necessary information.
Maintain accurate records of all authorization activities, communications, and determinations.
Stay current on payer policies, CMS regulations, and utilization management best practices.
Assist with appeals and peer-to-peer review coordination when necessary.
Meet productivity, turnaround time, quality, and compliance standards.

Required Qualifications

High school diploma or equivalent required; Associate's or Bachelor's degree in a healthcare-related field preferred.
Minimum of 2 years of experience in prior authorization, utilization review, medical insurance, case management, including admissions.
Strong understanding of commercial insurance, Medicare, Medicaid, and managed care plans.
Experience working with electronic medical records (EMR/EHR) and payer authorization portals.
Excellent organizational, analytical, and problem-solving skills.
Strong verbal and written communication abilities.
Ability to prioritize multiple tasks in a fast-paced healthcare environment.

Benefits:

Set schedule Monday- Friday 9 am- 5pm

Full benefit package available

Matching 401K

Time off accrued each payroll

Free employee meals

Quick Apply

Refine Your Search

insurance verification jobs in richmond, va

Clinical Authorization Specialist (Utilization Review)

Insurance Specialist - Home Care

Front Desk Representative

Care Coordination Assistant – Nursing Facility Attending Service

Leave Specialist - REMOTE

Patient Registrar Weekdays

Telehealth Coordinator Lead

Home Health Intake Lead

Outpatient Rehab Scheduler – Memorial Regional Medical Center Cardiopulmonary Rehabilitation

Patient Services Representative – Care-A-Van

Medical Office Representative - Oncology Clinic - Days

Patient Care Coordinator

Patient Care Representative

Imaging Center Front Desk Registrar - Weekend Hours

Front Desk Coordinator Surgery Center

Patient Care Coordinator II

Home Health Intake Lead

Scheduling Specialist - Tuckahoe Orthopaedic & Physical Therapy

Patient Logistic Specialist

Revenue Cycle & Patient Access Manager

I want to receive the latest job alert for insurance verification in richmond, va

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