Prior Authorization Specialist

DrFirst Inc.

23h•$50,000 - $59,000•Remote

About The Position

The Prior Authorization Specialist is responsible for researching, interpreting, and maintaining accurate prior authorization (PA) requirements for a variety of insurance payers. This role combines regulatory and operational knowledge with attention to detail and collaboration across internal teams to ensure the integrity of DrFirst’s rules engine and operational tools. The ideal candidate is experienced in PA workflows, highly organized, and comfortable parsing payer documentation into standardized internal formats. This role also requires a level of technical fluency: the ability to work alongside developers, data scientists, and product owners to continuously improve tooling, workflows, and automation. Candidates should be comfortable speaking the “language” of both healthcare operations and technology, and able to apply excel formulas, querying, or automation tools to improve the efficiency of their own tasks and the broader PA process.

Requirements

3+ years of hands-on experience in prior authorization processing or healthcare operations.
Strong knowledge of payer policies, benefits, and PA workflow structures.
Experience working with payer portals, benefit lookup tools, and medical policy documentation.
Excellent communication and documentation skills; able to interface with technical and non-technical stakeholders.
Comfortable working with structured logic, configuration tools, and basic scripting/querying to automate or optimize workflows.
Highly organized, detail-oriented, and able to manage multiple tasks in a remote, fast-paced setting.

Nice To Haves

Experience supporting automation or working with structured logic/rules-based tools is a plus.

Responsibilities

Research and interpret prior authorization rules and payer-specific requirements across service types and benefit types.
Use internal tools to enter unformatted payer guidelines into a standardized configuration format used by the DrFirst platform.
Keep payer documentation and configuration records up to date when prior authorization requirements change.
Collaborate cross-functionally with software development, product, and data science teams to suggest process improvements, validate enhancements, and test new automation or UI changes.
Identify opportunities to streamline tasks automation-enabling tools.
Interface with payers and vendors to clarify, confirm, and update contractual PA requirements.
Ensure PA configuration accuracy, completeness, and timely execution in support of client expectations and automation initiatives.
Participate in testing of new workflows, pilot projects, or tools related to PA processing.
Adhere to HIPAA, compliance, and internal data security standards.
Perform other tasks and support initiatives as assigned.

Benefits

Competitive compensation, with a base salary of $50,000-$59,000 (Exact compensation may vary based on skills and experience)
Eligible for Company Performance-based Bonus Program, based on individual and company performance
Medical, dental, and vision insurance
401K eligible after 3 months of employment, with 50% company match up to first 5% of salary contributed to the plan with a 3-year vesting schedule
HSA for eligible employees enrolled in the HDHP, with a generous company contribution up to $500 for individual coverage and $1000 for family coverage per year
100% company paid short and long-term disability, AD&D, and group life insurance
Accrued annual paid time off (PTO) of 18 days for the first 3 years of service, increasing thereafter and 7 paid holiday days
Employee Assistance Program
Continuing Education funds up to $1500 annually for eligible programs after 1 year of service
Voluntary benefits including FSA, Hospital indemnity, Accident and Critical Illness insurances