Authorization and Verification Research Specialist
About The Position
We're looking for a detail-oriented insurance verification and prior authorization expert who thrives on research and problem-solving. In this role, you'll investigate payor requirements across insurance plans—digging into portals, policy updates, and submission processes—to uncover the specific steps needed to successfully submit prior authorizations and verify benefits. You'll be our go-to researcher for understanding how different payors work, what documents they require, and how their processes vary across specialties. Your findings will directly enable our team to support healthcare providers and help patients access the care they need. This role is ideal for someone who loves the investigative side of insurance work, stays current on payor policy changes, and wants to build expertise across a wide range of insurance plans.
Requirements
- Prior authorization and/or insurance verification experience at a healthcare clinic
- Deep familiarity with payor submission processes and how requirements vary across different insurance plans
- Strong research skills and comfort navigating payor portals, websites, and documentation
- Exceptional attention to detail and ability to spot common authorization mistakes
- Experience working with multiple payors and understanding process variations
- Demonstrated ability to build or improve processes when protocols don't exist
- Resilient problem-solver who thrives in ambiguous, evolving environments
- Strong communication skills and comfort asking for help when needed
- Humility and willingness to learn from mistakes
Responsibilities
- Research and document prior authorization and benefit verification requirements across diverse payors (commercial plans, state Medicaid programs, etc.)
- Investigate payor-specific submission processes: required documents, portals, fax numbers, CPT code requirements, and policy updates
- Stay informed on payor policy changes, especially those affecting authorization processes and benefit structures
- Navigate payor websites, newsletters, and representative communications to gather accurate, up-to-date information
- Validate information from multiple sources and determine credibility of payor guidance
- Work independently to solve ambiguous problems where established processes don't yet exist
- Communicate findings clearly to cross-functional stakeholders and adapt quickly to feedback
- Handle tight deadlines and shifting priorities in a fast-paced startup environment
Benefits
- Fully remote
- All necessary devices and system access provided
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
Number of Employees
11-50 employees
