Startups · AI

Prior Authorization Specialist

Claimhealth · New York, NY, US · On-site

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About Claimhealth

AI Revenue Platform for Post-Acute Care. Backed by Peak XV and Y Combinator.

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.

What they're looking for

  • 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
More about this 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.

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.

Partner with product and engineering teams to translate complex payer rules into scalable workflows. Help define escalation logic,...

Read the full posting on Claimhealth's site ↗

Operations

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