Prior Authorization Specialist

About the RoleWe'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 DoAudit authorization workflowsReview 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 automationPartner 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 playbooksCreate and maintain SOPs covering authorization workflows across Medicare Advantage, Medicaid, managed Medicaid, commercial payers, and state-specific requirements.Partner with clientsMeet with intake, authorization, and billing teams to understand agency workflows, resolve escalations, and configure automation to match operational needs.Track operational performanceMonitor authorization turnaround times, approval rates, denial trends, escalation volume, payer response times, and automation success metrics. Drive continuous improvement initiatives.What We're Looking ForRequired3+ years of prior authorization experience within home health, hospice, or post-acute careDeep familiarity with Medicare Advantage, Medicaid, managed Medicaid, commercial insurance, and authorization workflowsExperience obtaining authorizations across multiple payer portalsStrong understanding of eligibility verification, authorization documentation requirements, and referral workflowsExperience with HomeCare HomeBase (HCHB), Axxess, WellSky, and KanTime preferredStrong organizational skills with excellent attention to detailExperience documenting workflows or SOPsComfortable working independently in a fast-moving startupNice to HaveRN, LPN, or clinical backgroundExperience with Careport, Forcura, Ensocare, or referral management platformsExperience working with automation or RCM software vendorsKnowledge of hospice-specific authorization requirements and Medicaid room & board processesWhy This RoleMultiply 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.