Top 285 Prior authorization Jobs in Washington, Dc

Referral Authorization Specialist
Samaritan —Washington, DC
- $21.24 - $28.84 an hour
- Full-time
- Remote
- Heavy lifting
- HIPAA
- Mid-level
Quick Apply
Clinic Operations Representative
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
Medical Support Assistant (Advanced)
US Veterans Health Administration —Washington, DC
- $59,102 - $76,832 a year
- Online Application
- Background check
- Customer service
- Medical office experience
6d
Registration Admission Rep I
MedStar Health —Washington, DC
- $22.21 - $33.79 an hour
- Full-time
- Hospital
- Word processing
- Computer literacy
Registration Admission Rep I (PRN)
MedStar Health —Washington, DC
- $22.22 - $33.79 an hour
- PRN
- Hospital
- Word processing
- Computer literacy
8d
Patient Access Representative
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- Microsoft Excel
- Computer literacy
- Mid-level
- Commuter assistance
- AD&D insurance
Medical Office Assistant III (Ortho)
MedStar Health —Washington, DC
- $27.67 - $41.77 an hour
- Full-time
- Hospital
- Word processing
- Basic math
Prior-Authorization Technician- Pharmacy
George Washington Medical Faculty Associates —Arlington, VA
- $23.46 - $30.50 an hour
- Mid-level
- High school diploma or GED
- Clinic
Quick Apply
Administrative Support Specialist
P3S CORPORATION —Washington, DC
- $65,000 - $80,000 a year
- Full-time
- Remote
- Microsoft Outlook
- Customer service
- Mid-level
Quick Apply
Clinic Operations Representative - PRN, Montgomery County (Mon - Fri, Day Shift)
Children's National Hospital —Silver Spring, MD
- $20.75 - $40.99 an hour
- PRN
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
- Commuter assistance
- AD&D insurance
Patient Access Rep- 8 hours weekly- Weekend
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Part-time
- Microsoft Excel
- Computer literacy
- HIPAA
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
Clinic Operations Representative - PRN (as-needed, weekdays only) - Takoma DC
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- PRN
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
- Commuter assistance
- AD&D insurance
Clinic Operations Representative - Ambulatory Center Services
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
- Commuter assistance
- AD&D insurance
Patient Registration Associate
MedStar Health —Washington, DC
- $18.70 - $32.72 an hour
- Full-time
- HIPAA
- High school diploma or GED
- Clinic
18h
Clinic Operations Representative - PRN Main Campus/DC Offices Hub (Mon-Fri, Day shift)
Children's National Hospital —Silver Spring, MD
- $20.75 - $40.99 an hour
- PRN
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
- Commuter assistance
- AD&D insurance
Clinic Operations Representative - Primary Care TheARC
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- Primary Care
- HIPAA
- Commuter assistance
- AD&D insurance
Clinic Operations Representative - Surgical Specialties (Washington DC)
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- Surgery
- HIPAA
- Commuter assistance
- AD&D insurance
Clinic Operations Representative - Primary Care Shepherd Park
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- Primary Care
- HIPAA
- Commuter assistance
- AD&D insurance
Clinic Operations Representative - ENT Clinic (Washington, DC)
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
- Commuter assistance
- AD&D insurance

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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 jobs in washington, dc

Referral Authorization Specialist

Clinic Operations Representative

Medical Support Assistant (Advanced)

Registration Admission Rep I

Registration Admission Rep I (PRN)

Patient Access Representative

Medical Office Assistant III (Ortho)

Prior-Authorization Technician- Pharmacy

Administrative Support Specialist

Clinic Operations Representative - PRN, Montgomery County (Mon - Fri, Day Shift)

Patient Access Rep- 8 hours weekly- Weekend

Pre-Registration Specialist, Per Diem

Clinic Operations Representative - PRN (as-needed, weekdays only) - Takoma DC

Clinic Operations Representative - Ambulatory Center Services

Patient Registration Associate

Clinic Operations Representative - PRN Main Campus/DC Offices Hub (Mon-Fri, Day shift)

Clinic Operations Representative - Primary Care TheARC

Clinic Operations Representative - Surgical Specialties (Washington DC)

Clinic Operations Representative - Primary Care Shepherd Park

Clinic Operations Representative - ENT Clinic (Washington, DC)

I want to receive the latest job alert for prior authorization in washington, dc

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