Claim Health
Prior Authorization Specialist
New York, NY, US · Full-time
Sponsorship not specified$55k-$75kDetected 2 days ago
Product ManagementProcess ImprovementOrganizational Skills
About the role
- Prior authorization is one of the largest operational bottlenecks for agencies.
- 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.
Responsibilities
- Partner with product and engineering teams to translate complex payer rules into scalable workflows.
- 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
- Drive continuous improvement initiatives.
Requirements
- Experience obtaining authorizations across multiple payer portals
- Strong understanding of eligibility verification, authorization documentation requirements, and referral workflows
- Experience documenting workflows or SOPs
Nice to have
- 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
- 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.
Compensation
- $55k-$75k
Benefits
- We're hiring an experienced Prior Authorization Specialist to help build the future of authorization automation for home health and hospice.
Apply directly at Claim Health →Create a free account for alerts like thisView Claim Health immigration profile
This listing is sourced directly from Claim Health's careers page and normalized into a canonical job model.