Prior Authorization Specialist

Claim Health • New York City, NY

25d • Remote

About The Position

We're hiring an experienced Prior Authorization Specialist to help build the future of authorization automation for home health and hospice. Prior authorization is one of the largest operational bottlenecks for agencies. Our platform automatically verifies benefits, gathers documentation, submits authorizations, follows up with payers, and monitors approval status. Your role is to ensure those automations run accurately, efficiently, and according to payer requirements. You'll combine deep operational knowledge with process improvement, helping us encode payer-specific workflows into software that scales across thousands of authorization requests. This isn't a traditional authorization desk role. It's an operations role for someone who understands the complexity of authorizations and wants to help automate them.

Requirements

• 3+ years of prior authorization experience within home health, hospice, or post-acute care
• Deep familiarity with Medicare Advantage, Medicaid, managed Medicaid, commercial insurance, and authorization workflows
• Experience obtaining authorizations across multiple payer portals
• Strong understanding of eligibility verification, authorization documentation requirements, and referral workflows
• Strong organizational skills with excellent attention to detail
• Experience documenting workflows or SOPs
• Comfortable working independently in a fast-moving startup

Nice To Haves

• Experience with HomeCare HomeBase (HCHB), Axxess, WellSky, and KanTime preferred
• RN, LPN, or clinical background
• Experience with Careport, Forcura, Ensocare, or referral management platforms
• Experience working with automation or RCM software vendors
• Knowledge of hospice-specific authorization requirements and Medicaid room & board processes

Responsibilities

• Audit authorization workflows
• Review authorization requests completed by our automations for completeness, accuracy, and turnaround time.
• Identify recurring failure points and determine whether issues stem from payer requirements, documentation, or automation logic.
• Improve authorization automation
• Partner with product and engineering teams to translate complex payer rules into scalable workflows.
• Help define escalation logic, documentation requirements, follow-up cadences, and exception handling.
• Build payer playbooks
• Create and maintain SOPs covering authorization workflows across Medicare Advantage, Medicaid, managed Medicaid, commercial payers, and state-specific requirements.
• Partner with clients
• Meet with intake, authorization, and billing teams to understand agency workflows, resolve escalations, and configure automation to match operational needs.
• Track operational performance
• Monitor authorization turnaround times, approval rates, denial trends, escalation volume, payer response times, and automation success metrics.
• Drive continuous improvement initiatives.

Benefits

• Multiply your impact. Your expertise becomes automation that processes thousands of authorizations every month.
• Solve hard operational problems. Help eliminate one of the biggest administrative burdens in post-acute care.
• Build the future. Join an early-stage healthcare AI company where your knowledge directly shapes the product roadmap.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed