Claim Health
Prior Authorization Specialist
New York City. Posted 3 months ago
The role
You will audit authorization workflows and improve authorization automation. You will partner with product and engineering teams to translate payer rules into scalable workflows.
What you will do
- Review authorization requests completed by automations for completeness, accuracy, and turnaround time.
- Identify recurring failure points in payer requirements, documentation, or automation logic.
- Partner with product and engineering teams to translate payer rules into scalable workflows.
- Help define escalation logic, documentation requirements, follow-up cadences, and exception handling.
- Create and maintain SOPs covering authorization workflows across various payers.
- Meet with client intake, authorization, and billing teams to understand workflows and resolve escalations.
- Monitor authorization turnaround times, approval rates, denial trends, and automation success metrics.
- Drive continuous improvement initiatives.
Required qualifications
- 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 have
- Experience with HomeCare HomeBase (HCHB), Axxess, WellSky, and KanTime
- 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
About the company
claim-health is an early-stage healthcare AI company building authorization automation for home health and hospice.