Prior Authorization Specialist
nationwidechildrens
Prior Authorization Specialist
claim-health· Operations
About this role
About the Role
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.
What You'll Do
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.
What We're Looking For
Required
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
Experience with HomeCare HomeBase (HCHB), Axxess, WellSky, and KanTime preferred
Strong organizational skills with excellent attention to detail
Experience documenting workflows or SOPs
Comfortable working independently in a fast-moving startup
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
Why This Role
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.
Frequently Asked Questions
Is the salary disclosed for the Prior Authorization Specialist position at claim-health?
The salary for this Prior Authorization Specialist role at claim-health is not publicly listed. Click "Apply Now" to learn more about the compensation package on their official careers page.
Where is the Prior Authorization Specialist position at claim-health located?
This Prior Authorization Specialist role at claim-health is based in New York City. The position is listed as on-site or hybrid. Check the full job description or apply directly to confirm the work arrangement.
Is the Prior Authorization Specialist role at claim-health full-time or part-time?
This is listed as a FullTime position. It is posted as a Prior Authorization Specialist role in the Operations department at claim-health.
Which team or department does the Prior Authorization Specialist at claim-health belong to?
This Prior Authorization Specialist position is part of the Operations department at claim-health. See the full job description for more information about the team structure and responsibilities.
How do I apply for the Prior Authorization Specialist position at claim-health?
Click the "Apply Now" button on this page. You will be redirected to claim-health's official application portal hosted on ashby where you can submit your application directly.
When was the Prior Authorization Specialist job at claim-health posted?
This Prior Authorization Specialist position at claim-health was posted on Jul 18, 2026. Apply as soon as possible — early applications are often reviewed first.
Prior Authorization Specialist
claim-health
You'll be redirected to claim-health's official application page on Ashby ATS.