Prior Authorization Specialist

Job Summary

A company is looking for a Prior Authorization Specialist responsible for managing prior authorization requirements for various insurance payers.

Key Responsibilities

• Research and interpret prior authorization rules and payer-specific requirements
• Enter payer guidelines into a standardized configuration format using internal tools
• Collaborate with cross-functional teams to suggest process improvements and validate enhancements

Required Qualifications

• 3+ years of experience in prior authorization processing or healthcare operations
• Strong knowledge of payer policies, benefits, and PA workflow structures
• Experience with payer portals and medical policy documentation
• Comfortable with structured logic and basic scripting/querying for workflow optimization
• Highly organized and able to manage multiple tasks in a remote, fast-paced environment